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Sergi CM, editor. Liver Cancer [Internet]. Brisbane (AU): Exon Publications; 2021 Apr 6. doi: 10.36255/exonpublications.livercancer.2021.ch7
Table 2
Overview of Locoregional Therapies
| Therapy | Mechanism | Primary Application | Complications | Advantages | Limitations |
|---|---|---|---|---|---|
| cTACE | Embolic ischemia augmented by emulsified chemotherapy | Larger (>3 cm) tumors Tumors <3 cm not amenable to resection/ablation | PES Liver failure GI ulcers Liver abscess Renal dysfunction | Studied extensively can be repeated | More systemic toxicity than DEB-TACE. Technical variability and non-standardized protocols Cannot be used with PVT |
| DEB-TACE | Embolic ischemia augmented by chemotherapeutic drug eluting beads. | Larger (>3 cm) tumors Tumors <3 cm not amenable to resection/ablation | Similar to cTACE | More controlled and sustained drug delivery than cTACE | More costly than cTACE. Cannot be used with PVT |
| TARE | Radiation induced cell death from Y-90 microspheres, minimal embolic effect | Larger (>3 cm) tumors Tumors <3 cm not amenable to resection/ablation | RILD Radiation induced pneumonitis Biliary stricturing Enteritis | Safe in PVT Slower TTP than TACE Outpatient procedure | Requires pre treatment mapping angiography More costly than TACE Requires higher level of expertise |
| Thermal Ablation (RFA) | High frequency alternating currents induce thermal injury and necrosis | Smaller (<3 cm) tumors, ≤3 nodules Improved outcomes combined with TACE for tumors 3-5 cm | Thermal injury to adjacent organs. Liver capsule rupture. Risk of peritoneal seeding treating peripheral tumors | Similar outcomes as surgical resection for tumors <3 cm (curative) Excellent safety profile | Heat sink effect. Limited efficacy in tumors >3 cm |
| SBRT | Multiple nonparallel radiation beams delivered in high-dose radiation fractions | Larger (>3 cm) tumors Tumors <3 cm not amenable to resection/ablation | Few: nausea, vomiting, GI ulcers (rare) | Alternative BT for patients with decompensated liver disease that are not LT candidates or failed other LRTs. Can treat lesions near adjacent organs, unlike ablation No heat sink effect Spares liver from RILD unlike TARE | Few comparative studies with other LRTs |
BT, bridging therapy; cTACE, conventional TACE; LRT, locoregional therapy; LT, liver transplant; OS, overall survival; PES, post embolization syndrome; PVT, portal vein thrombosis; RFA, radiofrequency ablation; TTP, time to progression; RILD, radiation induced liver injury
- Radioembolization using yttrium-90 microspheres as bridging and downstaging treatment for unresectable hepatocellular carcinoma before liver transplantation: initial single-center experience.[Transplant Proc. 2015]Radioembolization using yttrium-90 microspheres as bridging and downstaging treatment for unresectable hepatocellular carcinoma before liver transplantation: initial single-center experience.Abdelfattah MR, Al-Sebayel M, Broering D, Alsuhaibani H. Transplant Proc. 2015 Mar; 47(2):408-11.
- Effect of Downstaging and Bridging of Hepatocellular Carcinoma on Survival Following Liver Transplant: A Single Center Experience.[Exp Clin Transplant. 2017]Effect of Downstaging and Bridging of Hepatocellular Carcinoma on Survival Following Liver Transplant: A Single Center Experience.Al Sebayel MI, Elsiesy H, Al-Hamoudi W, Alabbad S, ElSheikh Y, Elbeshbeshy H, Salih I, Yousif S, Saleh Y, Eldali A, et al. Exp Clin Transplant. 2017 Mar; 15(Suppl 2):7-11.
- Review Liver transplantation for hepatocellular carcinoma with portal vein tumor thrombosis.[J Liver Cancer. 2021]Review Liver transplantation for hepatocellular carcinoma with portal vein tumor thrombosis.Kim SJ, Kim JM. J Liver Cancer. 2021 Sep; 21(2):105-112. Epub 2021 Sep 2.
- Downstaging therapy followed by liver transplantation for hepatocellular carcinoma beyond Milan criteria.[Surgery. 2017]Downstaging therapy followed by liver transplantation for hepatocellular carcinoma beyond Milan criteria.Kim Y, Stahl CC, Makramalla A, Olowokure OO, Ristagno RL, Dhar VK, Schoech MR, Chadalavada S, Latif T, Kharofa J, et al. Surgery. 2017 Dec; 162(6):1250-1258. Epub 2017 Oct 13.
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- Table 2, [Overview of Locoregional Therapies]. - Liver CancerTable 2, [Overview of Locoregional Therapies]. - Liver Cancer
- septin-4 isoform 4 [Homo sapiens]septin-4 isoform 4 [Homo sapiens]gi|311203834|ref|NP_001185642.1|Protein
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