Bridging locoregional therapy enhances long-term survivals in hepatocellular carcinoma patients listed for liver transplant within the milan criteria: a 15-year experience

No. 317 Bridging locoregional therapy enhances long-term survivals in hepatocellular carcinoma patients listed for liver transplant within the milan criteria: a 15-year experience M. Xing, S. Sakaria, R. Dhanasekaran, N. Kokabi, J.C. Camacho, S. Parekh, J.R. Spivey, H.S. Kim; Interventional Radiology and Image-Guided Medicine, Department of Radiology, Emory University School of Medicine, Atlanta, GA; Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA; Emory Transplant Center, Emory University School of Medicine, Atlanta, GA; Division of Interventional Radiology, Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA Purpose: To evaluate the long-term survival benefit of bridging locoregional therapy (LRT) prior to orthotopic liver transplant (OLT) in patients with hepatocellular carcinoma (HCC), within the Milan Criteria and listed for OLT. Materials and Methods: Under IRB approval, our transplant center registry was queried for all HCC patients within the Milan Criteria who were listed for OLT from June 1998 to August 2013. Baseline clinical characteristics, median overall survival (OS) from HCC diagnosis and median OS from OLT were calculated and stratified by LRT and OLT status. Survival analysis was conducted using Kaplan-Meier estimation and log-rank test. Results: A total of 265 HCC patients were listed for OLT 205 underwent OLT and 60 did not. Mean follow-up duration from HCC diagnosis was 7.6 years. Of the 205 transplanted patients, 111 received LRT prior to OLT (Group A), and 94 did not receive LRT (Group B). Both groups were similar for age at diagnosis, gender, race, lobar involvement, HCC etiology and mean largest tumor size (p40.05). Median OS from HCC diagnosis for Groups A and B were 87.3 months and 74.3 months, respectively (p1⁄40.01). Median OS from OLT for Groups A and B were 79.6 months and 64.9 months, respectively (p1⁄40.03). Interval survival rates from HCC diagnosis for Group A vs. B were: 91% vs. 76% (1 year), 85% vs. 65% (2 years), 72% vs. 53% (5 years, p1⁄40.02). Of 60 patients who were listed but did not undergo transplant, 44 received LRT (Group C) and 16 received best supportive care (Group D). Median OS from HCC diagnosis for Groups C and D were 37.1 months and 24.8 months (p1⁄40.03), respectively. Interval survival rates from HCC diagnosis for Group C vs. D were: 48% vs. 31% (1 year), 39% vs. 25% (2 years) and 18% vs. 6% (5 years, p1⁄40.005). Conclusion: Bridging locoregional therapy prior to OLT in patients with HCC within the Milan Criteria demonstrated significantly greater median OS and 5-year survival rates compared to those who did not receive LRT as a bridge to transplantation. P oters nd Exibits Abstract No. 318 Excellent response of VX2 liver metastases to iri delivered from 2 types of microspheres J. Namur, F.T. Pascale, M. Sterba, N. Maeda, S. Ghegediban, V. Verret, M. Wassef, A. Laurent; RD Interventional Radiology, University Of Osaka, Osaka, Japan; Pathology, APHP Lariboisiere Hospital, Paris, France; Cr2i, APHP INRA, Jouy en Josas, France; MSC, Paris University, Paris, France Purpose: Embolization microsphere loaded with irinotecan improve patient survival vs systemic FOLFIRI in liver metastases (Aliberti CIRSE 2011). In a model of VX2 liver metastases, we verified that the efficacy was due to irinotecan and not to the embolic and that two types of microspheres with different elution kinetics show different antitumor effects. Materials and Methods: VX2 cell suspension was injected in portal vein of 21 rabbits. After 14-21 days, multiple tumor nodules had developed in all liver lobes and embolization of common hepatic artery was performed with a fixed suspension volume of 1) bland Hepasphere 2) 100mg irinotecan-loaded HepaSphere 30/60mm, 3) 100mg irinotecan-loaded DC Bead 70-150mm. Five non-treated animals served as Control. Histology was performed at D3. Results: Liver tumor burden was significantly reduced in IRI treated group (5% total liver surface in HS-IRI, 17% in DCIRI) compared to Control (32%, p1⁄40.011). The reduction was not statistically significant for Bland HS (17%, p1⁄40.175). Tumor necrosis was significantly increased for both HS-IRI (70% total tumor surface, p1⁄40.006) and DC-IRI (50%, p1⁄40.047) vs Control (24%), while it did not increased significantly with Bland (22%, p1⁄40.465). HS-IRI were more frequently located outside tumor nodules (89%) than Bland HS (69%) and DC-IRI (52%). Necrosis of normal liver parenchyma was very limited (1% liver surface), NS between the four groups (p1⁄40.760). Conclusion: Irinotecan-loaded microspheres reduced tumor burden and caused significant necrosis of tumor nodules. This outcome was only due to irinotecan local delivery. The higher efficacy of HS-IRI vs DC-IRI may result from different elution kinetics or bead repartition in tumor/liver. Educational Exhibit Abstract No. 319 High dose rate (HDR) image-guided brachytherapy (IGBT): an introduction and pictorial review J. Park, C.T. Loh, D. Demanes, M. Kamrava, S.T. Kee, E.W. Lee; UCLA, Los Angeles, CA Learning Objectives: 1. To provide an introduction and overview of HDR-IGBT. 2. To guide the viewer through the indications, diagnostic imaging, interventional methods, contraindications, and potential complications of HDR-IGBT3. To provide a pictorial overview of cases performed in various organ systems. Background: Brachytherapy is applicable to a wide range of primary or recurrent cancers, including gynecologic, GI, head and neck, chest, breast, and soft tissue cancers. IR and brachytherapy can be used together to improve quality of cancer treatment.IGBT is the term used to describe the use of advanced IR techniques to place brachytherapy applicators followed by the other steps in the process of brachytherapy. The advantages of this approach are: 1. More accurate brachytherapy catheter distributions. 2. Reduced risk of injury to normal tissues through avoidance of penetration of major organs and blood vessels. 3. More efficient brachytherapy applications by combining imaging for applicator insertion with the Posters and Exhibits ’ JVIR S146 P os te rs an d Ex hi bi ts images used for the dosimetry. 4. Ability to treat deep lesions without the need for surgical exposure of the siteBrachytherapy is an effective treatment for a variety of cancers such as gynecologic, gastrointestinal, head and neck, chest, breast, and soft tissue cancers. IGBT can be used for the local ablation of metastatic or primary liver, retroperitoneal, and selected lung lesions that would otherwise require surgical exposure for placement of brachytherapy catheters. In contrast to thermal techniques such as radiofrequency ablation brachytherapy is not as dependent upon tumor location, size, or vascularity. Clinical Findings/Procedure Details: A. Brief overview of conventional brachytherapy and rationale behind HDRIGBT. B. Graphic and radiographic guide to HDR-IGBT technique C. Pictorial review of procedural imaging and outcomes of several HDR-IGBT cases, including liver, pancreas, soft tissue sarcoma, and head and neck sites. Conclusion and/or Teaching Points: HDR-IGBT is a novel and exciting tool that can be employed throughout the body to expand the repertoire of the interventional radiologist. The benefits and technique of HDR-IGBT are presented, as well as a pictorial review of cases at various body sites.