Chemoembolization vs Radioembolization: Which Is Better for Post-Transplant Outcomes?

Patients who were bridged/downstaged to orthotopic liver transplantation (OLT) by transarterial chemoembolization (TACE) or yttrium-90 (Y90) radioembolization had similar outcomes, even though Y90 patients waited longer for OLT. The researchers also observed a trend towards improved recurrence-free survival (RFS) in patients who were downstaged.

The study involved 172 patients with hepatocellular (HCC) carcinoma who were treated with liver-directed therapies prior to undergoing OLT at a large transplant center skilled in liver-directed procedures. During the first liver-directed therapy, patients’ median age was 60 years, and 57% had hepatitis C virus. There were 93 patients who underwent Y90 therapy prior to OLT and 79 patients who underwent TACE. The OLT took place between January 2003 and April 2013.

The researchers found that patients in the Y90 group had a longer time to OLT (6.5 months) compared with patients in the TACE group (4.8 months). After a median 26.1-month follow-up after OLT, 6/79 (8%) of TACE patients and 8/93 (9%) of Y90 patients had tumor recurrence.

For TACE patients, the median time-to-recurrence was 26.6, and for Y90 patients the median time-to-recurrence was 15.9 months. There were similar rates of recurrence-free survival and overall survival between the groups. Y90 patients had RFS of 79 months, compared with 77 months for TACE. After 100 months, approximately 57% of Y90 patients were alive, compared with 84.2 months for TACE.

There were 54 patients (Y90: 29; TACE: 25) of the 155 in the entire group who were downstaged to United Network Organ Sharing staging T2 or less, the researchers noted. For patients downstaged to T2 or less, the RFS hazard ratio was 0.6 (95% CI: 0.33-1.1), whereas those not downstaged to those levels had a hazard ratio of 1.7 (95% CI: 0.9-3.1). In addition, 17 patients greater than T2 (Y90: 8; TACE: 9) were downstaged to UNOS T2 or less, within transplant criteria.

The researchers said that more studies on outcomes following OLT are needed and should be conducted prospectively with adapted HCC recurrence screening protocols. They also recommend examining treatment options after HCC recurrence. “Hopefully, with a better understanding of the disease, post-transplant outcomes and treatment efficacy, guidelines of post-OLT HCC recurrence management and comprehensive algorithms could be proposed in the near future,” they wrote.

Reference

Gabr A, Abouchaleh N, Ali R, et al. Comparative study of post-transplant outcomes in hepatocellular carcinoma patients treated with chemoembolization or radioembolization. Eur J Radiol. 2017 Aug;93:100-106. doi: 10.1016/j.ejrad.2017.05.022.