Current locoregional therapies and treatment strategies in hepatocellular carcinoma

Locoregional therapies (LRT) play an important role in the treatment of hepatocellular carcinoma (HCC), with the aim of increasing overall survival while preserving liver function. Different forms of LRT are available and choosing which one is best will depend on technical aspects, liver morphology, tumor biology, and patient’s symptoms. The purpose of this review article is to provide an overview of the current evidence regarding the use of percutaneous ablation, transarterial chemoembolization and transarterial radioembolization for the curative or palliative treatment of HCC. Special situations are also reviewed, including the combined use of systemic therapy with LRT; indications and techniques for bridging to transplant and downstaging; and the use of LRT to treat patients with HCC and macrovascular invasion.

Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma

Primary liver cancer is the seventh most common cancer worldwide and is the second leading cause of cancer-related death. Hepatocellular carcinoma (HCC) accounts for three-quarters of primary liver cancers and less than a third of patients present with curable disease. Liver-directed therapy is essential for the treatment of patients with unresectable HCC and the advancement of stereotactic body radiation therapy (SBRT) has made radiation a safe and effective treatment option in a range of clinical presentations. In this review, we discuss the technical aspects of SBRT and the general approach to treatment of HCC. We explore the use of SBRT for bridging to transplant, downstaging, and the treatment of large tumors and portal vein tumor thrombus. Although there is limited high-quality randomized data, we review the evidence comparing SBRT with other liver-directed therapies and explore areas for future investigation.

CPR, ECLS, BVAD and Successful Heart Transplantation within 2 Months: A Single-centre Case Series in Two Young, High-urgency Listed Patients

Introduction In times of organ shortage, death while on the heart waiting-list still represents a major problem. As a consequence, bridging to transplant as well as the decision when to escalate therapy play a very important role. Methods and results We report on two young patients with dilated cardiomyopathy and acute decompensation who were successfully bridged to heart transplantation with both left and temporary right ventricular assist devices in just 2 months. Conclusions As a permanent biventricular assist device (BVAD) would have definitely impaired the patients' outcome after HTX, we decided to implant an LVAD with a temporary RVAD. In our opinion, this represents a suitable strategy to reduce mortality in HU-listed patients with acute deterioration of cardiac pump function and should be further evaluated in future studies.