Preoperative radioembolization versus chemoembolization and upfront resection for resectable hepatocellular carcinoma beyond the Milan criteria - Report - MDSpire
Conexiant’s news site is now MDSpire News. Learn more
Advertisement
Preoperative Radioembolization Compared with Chemoembolization or Immediate Resection for Resectable Hepatocellular Carcinoma Outside the Milan Criteria
Clinical Report: Preoperative Radioembolization for Resectable HCC Beyond Milan Criteria
Overview
This retrospective study evaluated preoperative transarterial radioembolization (TARE) and chemoembolization (TACE) against immediate resection in patients with technically resectable hepatocellular carcinoma (HCC) beyond the Milan criteria. The supplied article excerpt describes the study rationale, eligibility, and methods but provides no comparative outcomes; therefore, it does not establish which strategy was superior.
Background
HCC beyond the Milan criteria is associated with substantial risk of early recurrence after resection, while the optimal treatment for technically resectable disease remains uncertain. Existing guidance, as described in the article, considers evidence insufficient to determine whether resection is more beneficial than locoregional therapy in this population. TARE has been used across HCC stages, with cited studies reporting activity in selected early- and intermediate-stage unresectable disease, but evidence for its preoperative use in resectable high-risk HCC is limited. The study was designed to compare preoperative TARE and TACE with upfront resection.
Data Highlights
Study feature
Details reported
Design and setting
Retrospective review of consecutive patients at Seoul National University Hospital
Study period
January 2016 to July 2024
Strategies evaluated
Primary liver resection, preoperative TACE, or preoperative TARE
Eligibility
Age >18 years; technically resectable HCC beyond Milan criteria; adequate residual liver volume; ECOG performance status 0 or 1; Child–Pugh class A; acceptable operative risk
Definition of beyond Milan criteria
Single tumor >5 cm; 2–3 tumors with at least one >3 cm; or ≥4 tumors regardless of size
Interpretation of preoperative therapy
All patients were technically resectable at baseline and underwent resection; TACE and TARE were classified as neoadjuvant-intent therapies, not downstaging or transplant-bridging treatments
Comparative outcomes
Not included in the supplied excerpt
Key Findings
The study addressed a population with HCC beyond the Milan criteria that remained technically suitable for complete liver resection.
A multidisciplinary tumor board selected primary resection, preoperative TACE, or preoperative TARE based on tumor burden, liver function, technical resectability, and physician discretion.
Eligibility was restricted to patients with Child–Pugh class A liver function and ECOG performance status 0 or 1, among other operative and anatomic criteria.
Preoperative TACE and TARE were defined as neoadjuvant-intent therapies because all included patients were resectable at baseline and subsequently underwent liver resection.
The article introduction cites the phase II randomized TRACE trial as reporting superior tumor control and survival with TARE versus drug-eluting bead TACE in intermediate-stage unresectable HCC; this is contextual evidence, not a result of the present resectable-HCC cohort.
The supplied excerpt contains no patient counts, comparative survival estimates, recurrence outcomes, or perioperative results, so it does not support a conclusion about the relative effectiveness of the three strategies.
Clinical Implications
The excerpt supports interpreting the study as a comparison of treatment sequences in a selected, fit, Child–Pugh A population with technically resectable HCC beyond the Milan criteria. Because comparative outcomes are absent from the supplied material and treatment allocation was determined by a multidisciplinary board and physician discretion, no treatment preference or outcome-based clinical recommendation can be drawn from this excerpt.
Conclusion
The study was designed to assess preoperative TARE and TACE against immediate resection in resectable HCC beyond the Milan criteria. The available source material describes the rationale and methods but does not report results needed to determine comparative benefit.
by Jeayeon Park, Gyung Sun Lim, Yunmi Ko, Hyunjae Shin, Moon Haeng Hur, Su Young Hong, Suk Kyun Hong, Yun Bin Lee, Eun Ju Cho, Jeong-Hoon Lee, YoungRok Choi, Su Jong Yu, Hyo-Cheol Kim, Kwang-Woong Lee, Jung-Hwan Yoon, Kyung-Suk Suh, Jin Wook Chung, Yoon Jun Kim
