Pilot study of high‐intensity focused ultrasound ablation as a bridging therapy for hepatocellular carcinoma patients wait‐listed for liver transplantation. Issue 8 (24th June 2014)

• Record Type: Journal Article
• Authors: Chok, Kenneth S. H.; Cheung, Tan To; Lo, Regina C. L.; Chu, Ferdinand S. K.; Tsang, Simon H. Y.; Chan, Albert C. Y.; Sharr, William W.; Fung, James Y. Y.; Dai, Wing Chiu; Chan, See Ching; Fan, Sheung Tat; Lo, Chung Mau
• Is Part Of: Liver transplantation. Volume 20:Issue 8(2014:Aug.)
• Page Start: 912
• Page End: 921
• Publication Date: 2014-06-24
• Subjects: Liver -- Transplantation -- Periodicals; Liver -- Diseases -- Periodicals; Liver Transplantation -- Periodicals; Foie -- Greffe -- Périodiques; 617.5560592
• DOI: 10.1002/lt.23892
• Languages: English
• ISSNs: 1527-6465

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <p>The objective of this study was to investigate the outcomes of high‐intensity focused ultrasound (HIFU) ablation as a bridging therapy for patients with hepatocellular carcinoma (HCC) who had been wait‐listed for deceased donor liver transplantation (DDLT). Adult patients with unresectable and unablatable HCCs within the University of California San Francisco criteria who had been wait‐listed for DDLT were screened for their suitability for HIFU ablation as a bridging therapy if they were not suitable for transarterial chemoembolization (TACE). Treatment outcomes for patients receiving HIFU ablation, TACE, and best medical treatment (BMT) were compared. Fifty‐one patients were included in the analysis. Before the introduction of HIFU ablation, only 39.2% of the patients had received bridging therapy (TACE only, n = 20). With HIFU ablation in use, the rate increased dramatically to 80.4% (TACE + HIFU, n = 41). The overall dropout rate was 51% (n = 26). Patients in the BMT group had a significantly higher dropout rate (<italic>P</italic> = 0.03) and significantly poorer liver function as reflected by higher Model for End‐Stage Liver Disease scores and higher Child‐Pugh grading. Clinically relevant ascites was found in 5 patients in the HIFU group and 2 patients in the BMT group, but none was found in the TACE group (<italic>P</italic> = 0.01 and <italic>P</italic> = 0.03, respectively). The TACE and HIFU groups had comparable percentages of tumor necrosis in excised livers (<italic>P</italic> = 0.35), and both were significantly higher than that in the BMT group (<italic>P</italic> = 0.01 and <italic>P</italic> = 0.02, respectively). In conclusion, HIFU ablation was safe even for HCC patients with Child‐Pugh C disease. Its adoption increased the percentage of patients receiving bridging therapy from 39.2% to 80.4%. A randomized controlled trial for further validation of its efficacy is warranted. <italic>Liver Transpl 20:912–921, 2014</italic>. © 2014 AASLD.</p> </abstract>