Histomorphologic Analysis of Preoperative Intensity Modulated Radiotherapy (IMRT) and Chemoembolization for Hepatocellular Carcinoma in Liver Explants
C Gimenez, HK Islam, M Facciuto, US Katta. New York Medical College at Westchester Medical Center, Valhalla, NY
Background: Preoperative adjuvant therapies are documented to improve the overall survival of liver transplant recipients with concurrent hepatocellular carcinoma (HCC) and various therapeutic modalities are described including recently used IMRT (Intensity Modulated RadioTherapy). In this study, we analyzed the histomorphologic effects of IMRT on HCC as well as in the adjacent parenchyma; and compared them with those of chemoembolization.
Design: Thirty cases of ESLD (end stage liver disease) with concurrent HCC who underwent preoperative adjuvant therapy (15, IMRT; 15, chemoembolization) prior to liver transplant with documented histologic findings of therapy effects were included in this study. The histologic slides were retrieved from our archives and reviewed by 2 different pathologists and consensus findings were graded for final interpretation. Extent of therapy induced tumor necrosis was graded as, 0, 0-5% necrosis, grade 1, 6-50% necrosis, and grade 2-≥50% necrosis. Congestion and hemorrhage were interpreted as undesirable side effects.
Results: In IMRT group, tumor necrosis was observed in 53% (8/15) cases; 13% with grade 1 and 40% with grade 2 necrosis while 47% cases showed no tumor necrosis (grade 0). Undesirable side effects were noted in 67% (10/15) cases, however, all of them were confined within 5 mm area around the targeted tumor nodules, except in one case, where the targeted tumor was missed. In contrast, in the chemoembolization group, tumor necrosis was achieved in 87% (13/15) cases; 20% with grade 1 and 67% with grade 2 while only 13% cases showed no therapy induced tumor necrosis (grade 0). Side effects in the latter group are more haphazard and not limited to immediate surrounding areas.
Conclusions: IMRT, a relatively less invasive procedure, is recently described as a modality of adjuvant therapy for HCC in ESLD, who subsequently requires liver transplantation. Our preliminary data suggests that it may have lesser overall effects in inducing tumor necrosis but it can target the lesions more precisely and the side effects are essentially confined to immediate surrounding areas as compared to other modalities, namely chemoembolization. IMRT, thus, may have the potential of minimal functional damage as compared to others, especially in the setting of ESLD with already compromised liver functions.
Category: Liver & Pancreas
Tuesday, March 23, 2010 9:30 AM
Poster Session III # 233, Tuesday Morning