SIR 2024
Interventional Oncology
McKenzie Mosenthal, MD
Interventional Radiology Fellow
Loyola University Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Rohit Anand, MD
Diagnostic Radiology Resident Physician
Loyola University Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Christopher Molvar, MD
Interventional Radiologist
Loyola University Medical Center
Disclosure information not submitted.
Compare pathologic tumor necrosis after locoregional therapies (LRT) for hepatocellular carcinoma (HCC) prior to liver transplantation and evaluate radiologic-pathologic correlation, along with post-transplant HCC recurrence.
Materials and Methods: Consecutive patients with solitary HCC bridged/downstaged with LRT from 2010-2022 were included. LRTs were transarterial chemoembolization (TACE), radioembolization (Y90), ablation, and stereotactic body radiotherapy (SBRT). Upfront combination therapy options were TACE/ablation and TACE/SBRT. Subsequent therapy crossover due to local recurrence was allowed. Post-treatment imaging closest to time of transplant, explant histopathologic necrosis, and tumor recurrence after transplant were reviewed.
Results:
Seventy-three patients met inclusion criteria of whom 5 (7%) required downstaging. Y90 alone (n = 36) and multimodal therapy (pooled upfront combination and crossover therapy, n = 23), resulted in significantly greater pathologic necrosis compared to TACE alone (n = 14, p = 0.01). Radiation segmentectomy (>190Gy, n=27) and TACE/ablation (n=7) showed highest rates of complete pathologic necrosis (CPN) - 63% (n = 17) and 71% (n = 5), respectively. Patients with CPN had a mean lesion size of 2.5cm, compared to 3.2cm without CPN (p = 0.04), irrespective of LRT modality. HCC recurrence was more common in patients without CPN (6/37) compared to those with CPN (1/36, p=0.11). Using Liver Imaging Reporting and Data System (LI-RADS), nonviable imaging response was 75% sensitive and 57% specific for CPN.
Conclusion: Radiation segmentectomy and multimodal therapy, significantly improved CPN rates compared to TACE alone; paralleling those seen with TACE/ablation. An imaging response of LR-TR nonviable did not confidently predict CPN.