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Transplantation for hepatocellular carcinoma: Management of patients on the waiting list

✍ Scribed by Pietro Majno; Gilles Mentha; Christian Toso; for the Geneva Liver Cancer Study Group

Publisher
John Wiley and Sons
Year
2010
Tongue
English
Weight
125 KB
Volume
16
Category
Article
ISSN
1527-6465

No coin nor oath required. For personal study only.

✦ Synopsis

In discussing the mananagement of patients in the waiting list, the terms neoadjuvant treatment, bridging, downstaging and dropout should be used consistently, and on the basis of accepted selection criteria (currently MC, incorporated into the tumor-nodemetastasis [TNM] staging system as follows: T1, 1 nodule < 2 cm in diameter, and T2, 3 nodules up to 3 cm in diameter or 1 nodule up to 5 cm in diameter with no vascular invasion or extrahepatic spread [VI/ES]).

Neoadjuvant Treatments

Neoadjuvant treatments are given before a procedure to improve its outcome; they achieve this improvement generally by making more patients eligible for the procedure or by improving the results of the procedure. In the context of OLT for HCC, neoadjuvant treatments [typically locoregional treatments (LRTs) such as transarterial chemoembolization (TACE) and radiofrequency thermal ablation (RFTA)] can be used for bridging or downstaging, as defined below.

Bridging

We reserve the term bridging for strategies that are implemented in patients who already qualify for transplantation according to standard selection criteria so that they can wait until they receive a graft. A bridging strategy

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