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For patients with early-stage hepatocellular carcinoma (HCC), liver transplantation is typically recognized as the optimal treatment. Yet, for many patients diagnosed with liver cancer, the tumor at first diagnosis is already advanced beyond the curative treatment option according to the Milan criteria, accepted as the standard criteria for transplant. 

In a study headed by William C. Chapman, MD, FACS, chief of general surgery and chief of abdominal transplantation, researchers looked at the long-term risks of using transarterial chemoembolization (TACE) pre-transplant to downstage end-stage (stage III/IV) HCC patients to meet Milan criteria. 

Of the 202 patients referred with HCC, 136 were candidates for TACE. Of those, 76 were stage III to IV. In the end, 26 recipients with stage II disease were candidates for transplant, while 17 with stage III/IV were able to be downstaged to meet the stage II Milan criteria. Most underwent just two TACE sessions to reach adequate downstaging. 

Researchers found that patients downstaged from stage III or IV HCC using TACE had the same long-term consequences and recurrence rate as patients who originally only had stage II disease. They propose this therapy strategy be considered for patients with HCC confined to the liver who do not meet Milan criteria but who are otherwise transplant candidates. Chapman WC et al. Outcomes of Neoadjuvant Transarterial Chemoembolization to Downstage Hepatocellular Carcinoma Before Liver Transplant. Annals of Surgery, vol 248 (4). 
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