Published online May 14, 2014. doi: 10.3748/wjg.v20.i18.5308
Revised: February 8, 2014
Accepted: February 20, 2014
Published online: May 14, 2014
Liver transplantation (LT) for hepatocellular carcinoma (HCC) within Milan criteria is a widely accepted optimal therapy. Neo-adjuvant therapy before transplantation has been used as a bridging therapy to prevent dropout during the waiting period and as a down-staging method for the patient with intermediate HCC to qualify for liver transplantation. Transarterial chemoembolization and radiofrequency ablation are the most commonly used method for locoregional therapy. The data associated with newer modalities including drug-eluting beads, radioembolization with Y90, stereotactic radiation therapy and sorafenib will be discussed as a tool for converting advanced HCC to LT candidates. The concept “ablate and wait” has gained the popularity where mandated observation period after neo-adjuvant therapy allows for tumor biology to become apparent, thus has been recommended after down-staging. The role of neo-adjuvant therapy with conjunction of “ablate and wait” in living donor liver transplantation for intermediate stage HCC is also discussed in the paper.
Core tip: Transarterial chemoembolization (TACE) and radiofrequency ablation are effective in down-staging intermediate staged hepatocellular carcinoma (HCC) to fulfill Milan criteria for liver transplantation (LT). New techniques using drug eluting beads-TACE, transarterial radioembolization and stereotactic radiation therapy have shown promising results in the treatment for advanced HCC over conventional TACE. In current practice, use of multimodality approach, taking advantage of the benefits of different locoregional therapy for HCC have been adopted as down-staging and bridging therapy for LT. Use of mandatory observation period prior to LT can exclude highly aggressive liver cancer that might not benefit from LT.