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Living Donor Liver Transplantation for Advanced Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis after Concurrent Chemoradiation Therapy

 Dai Hoon Han  ;  Dong Jin Joo  ;  Myoung Soo Kim  ;  Gi Hong Choi  ;  Jin Sub Choi  ;  Young Nyun Park  ;  Jinsil Seong  ;  Kwang-Hyub Han  ;  Soon Il Kim 
 Yonsei Medical Journal, Vol.57(5) : 1276-1281, 2016 
Journal Title
 Yonsei Medical Journal 
Issue Date
Adult ; Carcinoma, Hepatocellular/complications ; Carcinoma, Hepatocellular/drug therapy ; Carcinoma, Hepatocellular/surgery ; Carcinoma, Hepatocellular/therapy* ; Chemoradiotherapy* ; Cisplatin/therapeutic use ; Disease-Free Survival ; Female ; Fluorouracil/therapeutic use ; Humans ; Liver Neoplasms/complications ; Liver Neoplasms/drug therapy ; Liver Neoplasms/surgery ; Liver Neoplasms/therapy* ; Liver Transplantation* ; Living Donors* ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Portal Vein* ; Venous Thrombosis/complications*
Concurrent chemoradiation ; down-staging ; hepatocellular carcinoma ; living donor liver transplantation ; thrombus
Locally advanced hepatocellular carcinoma (HCC) with portal vein thrombosis carries a 1-year survival rate <10%. Localized concurrent chemoradiotherapy (CCRT), followed by hepatic arterial infusion chemotherapy (HAIC), was recently introduced in this setting. Here, we report our early experience with living donor liver transplantation (LDLT) in such patients after successful down-staging of HCC through CCRT and HAIC. Between December 2011 and September 2012, eight patients with locally advanced HCC at initial diagnosis were given CCRT, followed by HAIC, and underwent LDLT at the Severance Hospital, Seoul, Korea. CCRT [45 Gy over 5 weeks with 5-fluorouracil (5-FU) as HAIC] was followed by HAIC (5-FU/cisplatin combination every 4 weeks for 3-12 months), adjusted for tumor response. Down-staging succeeded in all eight patients, leaving no viable tumor thrombi in major vessels, although three patients first underwent hepatic resections. Due to deteriorating liver function, transplantation was the sole therapeutic option and offered a chance for cure. The 1-year disease-free survival rate was 87.5%. There were three instances of post-transplantation tumor recurrence during follow-up monitoring (median, 17 months; range, 10-22 months), but no deaths occurred. Median survival time from initial diagnosis was 33 months. Four postoperative complications recorded in three patients (anastomotic strictures: portal vein, 2; bile duct, 2) were resolved through radiologic interventions. Using an intensive tumor down-staging protocol of CCRT followed by HAIC, LDLT may be a therapeutic option for selected patients with locally advanced HCC and portal vein tumor thrombosis.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
김명수(Kim, Myoung Soo) ORCID logo https://orcid.org/0000-0002-8975-8381
김순일(Kim, Soon Il) ORCID logo https://orcid.org/0000-0002-0783-7538
박영년(Park, Young Nyun) ORCID logo https://orcid.org/0000-0003-0357-7967
성진실(Seong, Jin Sil) ORCID logo https://orcid.org/0000-0003-1794-5951
주동진(Joo, Dong Jin) ORCID logo https://orcid.org/0000-0001-8405-1531
최기홍(Choi, Gi Hong) ORCID logo https://orcid.org/0000-0002-1593-3773
최진섭(Choi, Jin Sub)
한광협(Han, Kwang-Hyub) ORCID logo https://orcid.org/0000-0003-3960-6539
한대훈(Han, Dai Hoon) ORCID logo https://orcid.org/0000-0003-2787-7876
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