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Review
. 2023 Apr 2;15(7):2122.
doi: 10.3390/cancers15072122.

Selecting the Appropriate Downstaging and Bridging Therapies for Hepatocellular Carcinoma: What Is the Role of Transarterial Radioembolization? A Pooled Analysis

Victor Lopez-Lopez  1   2   3 , Kohei Miura  4 , Christoph Kuemmerli  5 , Antonio Capel  6 , Dilmurodjon Eshmuminov  7 , David Ferreras  1   2 , Alberto Baroja-Mazo  2 , Pedro Cascales-Campos  1   2 , María Isabel Jiménez-Mascuñán  1   2 , José Antonio Pons  8 , Maria Isabel Castellon  9 , Francisco Sánchez-Bueno  1   2 , Ricardo Robles-Campos  1   2 , Pablo Ramírez  1   2
Affiliations
Review

Selecting the Appropriate Downstaging and Bridging Therapies for Hepatocellular Carcinoma: What Is the Role of Transarterial Radioembolization? A Pooled Analysis

Victor Lopez-Lopez et al. Cancers (Basel). .

Abstract

Background: Transarterial radioembolization in HCC for LT as downstaging/bridging has been increasing in recent years but some indication criteria are still unclear.

Methods: We conducted a systematic literature search of primary research publications conducted in PubMed, Scopus and ScienceDirect databases until November 2022. Relevant data about patient selection, HCC features and oncological outcomes after TARE for downstaging or bridging in LT were analyzed.

Results: A total of 14 studies were included (7 downstaging, 3 bridging and 4 mixed downstaging and bridging). The proportion of whole liver TARE was between 0 and 1.6%. Multiple TARE interventions were necessary for 16.7% up to 28% of the patients. A total of 55 of 204 patients across all included studies undergoing TARE for downstaging were finally transplanted. The only RCT included presents a higher tumor response with the downstaging rate for LT of TARE than TACE (9/32 vs. 4/34, respectively). Grade 3 or 4 adverse effects rate were detected between 15 and 30% of patients.

Conclusions: TARE is a safe therapeutic option with potential advantages in its capacity to necrotize and reduce the size of the HCC for downstaging or bridging in LT.

Keywords: bridging; downstaging; hepatocellular carcinoma; liver transplant; transarterial radioembolization.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of study selection following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses). HCC: hepatocellular carcinoma, LT: liver transplant, TARE: transarterial radioembolization, LRT: locoregional therapy.
Figure 2
Figure 2
Various TARE procedures. (A) Types of TAREs: total (whole liver), bilobar (2 catheters), lobar or segmental and subsegmental; (B) Segmental TARE: before and after (healthy lobe hypertrophy and diseased segment atrophy); (C) TARE in 2 phases: boost in LOE and lower dose in the corresponding lobe. Finally, atrophy of the diseased lobe and hypertrophy of the healthy lobe.
Figure 3
Figure 3
Results of pooled single-arm analyses. (A) Proportion of patients proceeding to transplant; (B) proportion of patients with either complete or partial response of the tumor; (C) proportion of patients with 100% tumor necrosis on histological assessment.
Figure 4
Figure 4
TARE response to HCC in 14 studies. Data on the effect of tumor treatment on TARE were extracted from each study and summarized: HCC: hepatocellular carcinoma, TARE: transarterial radioembolization, CR: complete response, PR: partial response, SD: stable disease, PD: progressive disease.
Figure 5
Figure 5
General aspects of the criteria for downstaging in patients with hepatocellular carcinoma who are candidates for liver transplantation. (A) Single lesion; (B)Two or more lesions.
See this image and copyright information in PMC

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