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World J Gastroenterol. May 14, 2014; 20(18): 5308-5319
Published online May 14, 2014. doi: 10.3748/wjg.v20.i18.5308
Neo-adjuvant therapy for hepatocellular carcinoma before liver transplantation: Where do we stand?
Masato Fujiki, Federico Aucejo, Minsig Choi, Richard Kim
Masato Fujiki, Federico Aucejo, Transplant Center, Cleveland Clinic, Cleveland, OH 44195, United States
Minsig Choi, Department of Gastrointestinal Oncology, Wayne State University/Karmonos Cancer Center Detroit, MI 48202, United States
Richard Kim, Department of Gastrointestinal Oncology, H Lee Moffitt Cancer Center, Tampa, FL 33612, United States
Author contributions: Kim R, Aucejo F, Choi M and Fujiki M designed research; Fujiki M analyzed data; Fujiki M, Choi M and Kim R wrote the paper.
Correspondence to: Richard Kim, MD, Department of Gastrointestinal Oncology, H Lee Moffitt Cancer Center, 12902 Magnolia Drive FOB-2, Tampa, FL 33612, United States. richard.kim@moffitt.org
Telephone: +1-813-7451277 Fax: +1-813-4498553
Received: September 28, 2013
Revised: February 8, 2014
Accepted: February 20, 2014
Published online: May 14, 2014
Processing time: 229 Days and 23.7 Hours
Core Tip

Core tip: Transarterial chemoembolization (TACE) and radiofrequency ablation are effective in down-staging intermediate staged hepatocellular carcinoma (HCC) to fulfill Milan criteria for liver transplantation (LT). New techniques using drug eluting beads-TACE, transarterial radioembolization and stereotactic radiation therapy have shown promising results in the treatment for advanced HCC over conventional TACE. In current practice, use of multimodality approach, taking advantage of the benefits of different locoregional therapy for HCC have been adopted as down-staging and bridging therapy for LT. Use of mandatory observation period prior to LT can exclude highly aggressive liver cancer that might not benefit from LT.