ojrdrtОнкологический журнал: лучевая диагностика, лучевая терапияJournal of oncology: diagnostic radiology and radiotherapy2587-75932713-167XНЕКОММЕРЧЕСКОЕ ПАРТНЕРСТВО «ОБЩЕСТВО ИНТЕРВЕНЦИОННЫХ ОНКОРАДИОЛОГОВ»10.37174/2587-7593-2023-6-3-81-89ojrdrt-320Research ArticleКЛИНИЧЕСКИЕ СЛУЧАИCLINICAL CASESТрансартериальная химиоэмболизация в комбинированном лечении больных с прогрессированием гепатоцеллюлярного рака в аллотрансплантате печени: клинический случайTransarterial Chemoembolization in Therapy of Patients with Recurrence of Hepatocellular Cancer in a Liver Transplant: a Clinical Casehttps://orcid.org/0000-0002-4006-3642ВиршкеЭ. Р.VirshkeE. R.

Виршке Эдуард Рейнгольдович  — д.м.н., заведующий рентгенооперационным блоком отдела интервенционной радиологии

115478 Москва, Каширское шоссе, 24

24 Kashirskoye Shosse, Moscow, 115478

virshke@mail.ruhttps://orcid.org/0000-0002-6323-511XДжанянИ. А.DzhanyanI. A.

Джанян Ирина Анатольевна — врач-онколог онкологического отделения лекарственных методов лечения (химиотерапевтическое) №17

115478 Москва, Каширское шоссе, 24

24 Kashirskoye Shosse, Moscow, 115478

https://orcid.org/0000-0002-4587-4153ПогребняковИ. В.PogrebnyakovI. V.

Погребняков Игорь Владимирович — к.м.н., заведующий отделением рентгенохирургических методов диагностики и лечения отдела интервенционной радиологии

115478 Москва, Каширское шоссе, 24

24 Kashirskoye Shosse, Moscow, 115478

https://orcid.org/0000-0002-6244-4294БредерВ. В.BrederV. V.

Бредер Валерий Владимироваич — д.м.н., в.н.с. онкологического отделения лекарственных методов лечения (химиотерапевтическое) №17

115478 Москва, Каширское шоссе, 24

24 Kashirskoye Shosse, Moscow, 115478

https://orcid.org/0000-0002-6362-7914НоврузбековМ. С.NovruzbekovM. S.

Новрузбеков Мурад Сафтарович — д.м.н., профессор, заведующий отделением трансплантации печени

129090, Москва, Большая Сухаревская пл., 3

3 B. Sukharevskaya Sq., Moscow, 129090

https://orcid.org/0000-0002-0691-5581ОлисовО. Д.OlisovO. D.

Олисов Олег Даниелович — к.м.н., с.н.с. отделения трансплантации печени

129090, Москва, Большая Сухаревская пл., 3

3 B. Sukharevskaya Sq., Moscow, 129090

https://orcid.org/0000-0001-7185-7165ДолгушинБ. И.DolgushinB. I.

Долгушин Борис Иванович  — д.м.н., профессор, академик РАН, директор

115478 Москва, Каширское шоссе, 24

24 Kashirskoye Shosse, Moscow, 115478

Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина Минздрава РоссииРоссияN.N. Blokhin National Medical Research Center of OncologyRussian FederationНаучно-исследовательский институт скорой помощи им. Н.В. Склифосовского ДЗМРоссияN.V. Sklifosovsky Research Institute for Emergency MedicineRussian Federation202316102023638189Copyright © Виршке Э.Р., Джанян И.А., Погребняков И.В., Бредер В.В., Новрузбеков М.С., Олисов О.Д., Долгушин Б.И., 20232023Виршке Э.Р., Джанян И.А., Погребняков И.В., Бредер В.В., Новрузбеков М.С., Олисов О.Д., Долгушин Б.И.Virshke E.R., Dzhanyan I.A., Pogrebnyakov I.V., Breder V.V., Novruzbekov M.S., Olisov O.D., Dolgushin B.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.oncoradjournal.ru/jour/article/view/320

Резекция и ортотопическая трансплантация печени считаются радикальными методами лечения больных с гепатоцеллюлярным раком. Однако у 6–20 % пациентов, перенесших трансплантацию печени по поводу гепатоцеллюлярного рака, наблюдается прогрессирование. При этом примерно в 20 % случаев отмечается изолированное поражение аллотрансплантата, а сочетание внутри- и внепеченочного метастазирования наблюдается не менее чем у 30 % больных. На момент выявления прогрессирования ГЦР в аллотрансплантате большинство больных уже не подлежат радикальному лечению из-за наличия мультифокального билобарного поражения печени или внепеченочного метастазирования. Поэтому у них трансартериальная химиоэмболизация (ТАХЭ) может являться эффективным методам лечения, обеспечивая длительный локальный контроль опухолевого процесса в аллотрансплантате печени. 

Resection and orthotopic liver transplantation are considered radical methods in patients with hepatocellular cancer (HCC). However, recurrence is observed in 6-20 % of patients who have undergone liver transplantation for hepatocellular cancer. In about 20 % of cases there is an local lesion of the transplant, and a combination of intra- and extrahepatic metastasis is observed in at least 30 % of patients. At the time of detection of the recurrence of HCC in the liver transplant, most patients are no longer subject to radical treatment due to the presence of multifocal bilobar liver damage or extrahepatic metastasis. Transarterial chemoembolization (TACE) can be a method of choice, can make it possible long-term local control of the tumor process in the liver transplant.

гепатоцеллюлярный ракортотопическая трансплантация печенипрогрессированиекомбинированное лечениетрансартериальная химиоэмболизацияклинический случайhepatocellular cancerorthotopic liver transplantationrecurrence after liver transplantationtransarterial chemoembolizationClinical CaseReferencesEASL Clinical Practice Guidelines. Management of hepatocellular carcinoma. J Hepatol. 2018;69(1):182–236, doi: 10.1016/j.jhep.2018.03.019.EASL Clinical Practice Guidelines. Management of hepatocellular carcinoma. J Hepatol. 2018;69(1):182–236, doi: 10.1016/j.jhep.2018.03.019.Tang A, Hallouch O, Chernyak V. et al. Epidemiology of hepatocellular carcinoma: target population for surveillance and diagnosis. In: Abdominal Radiology. Vol. 43, Springer New York LLC. 2018:13-25. doi: 10.1007/s00261-017-1209.Tang A, Hallouch O, Chernyak V. et al. Epidemiology of hepatocellular carcinoma: target population for surveillance and diagnosis. In: Abdominal Radiology. Vol. 43, Springer New York LLC. 2018:13-25. doi: 10.1007/s00261-017-1209.Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival. Hepatology (Baltimore, MD). 2003;37(2):429–42, doi: 10.1053/jhep.2003.50047.Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival. Hepatology (Baltimore, MD). 2003;37(2):429–42, doi: 10.1053/jhep.2003.50047.Maluccio M, Covey A. Recent progress in understanding, diagnosing, and treating hepatocellular carcinoma. CA cancer j clin. 2012;62(6):394–9, doi: 10.3322/caac.21161.Maluccio M, Covey A. Recent progress in understanding, diagnosing, and treating hepatocellular carcinoma. CA cancer j clin. 2012;62(6):394–9, doi: 10.3322/caac.21161.Welling TH., Eddinger K , Carrier K. et al. Multicenter Study of Staging and Therapeutic Predictors of Hepatocellular Carcinoma Recurrence following Transplantation Liver Transpl. 2018 September; 24(9): 1233–1242. doi:10.1002/lt.25194.Welling TH., Eddinger K , Carrier K. et al. Multicenter Study of Staging and Therapeutic Predictors of Hepatocellular Carcinoma Recurrence following Transplantation Liver Transpl. 2018 September; 24(9): 1233–1242. doi:10.1002/lt.25194.Alshahrani AA, Ha SM, Hwang S. et al. Clinical Features and Surveillance of Very Late Hepatocellular Carcinoma Recurrence After Liver Transplantation. Ann Transplant. 2018 Sep 21;23:659-665. doi: 10.12659/AOT.910598.Alshahrani AA, Ha SM, Hwang S. et al. Clinical Features and Surveillance of Very Late Hepatocellular Carcinoma Recurrence After Liver Transplantation. Ann Transplant. 2018 Sep 21;23:659-665. doi: 10.12659/AOT.910598.Samuel D and Coilly A, Management of patients with liver diseases on the waiting list for transplantation: a major impact to the success of liver transplantation, BMC Medicine (2018) 16:113, doi: 10.1186/s12916-018-1110-y.Samuel D and Coilly A, Management of patients with liver diseases on the waiting list for transplantation: a major impact to the success of liver transplantation, BMC Medicine (2018) 16:113, doi: 10.1186/s12916-018-1110-y.Au KP, Chok KSH. Multidisciplinary approach for post-liver transplant recurrence of hepatocellular carcinoma: A proposed management algorithm, World J Gastroenterol 2018 December 7; 24(45): 5081-5094, doi: 10.3748/wjg.v24.i45.5081.Au KP, Chok KSH. Multidisciplinary approach for post-liver transplant recurrence of hepatocellular carcinoma: A proposed management algorithm, World J Gastroenterol 2018 December 7; 24(45): 5081-5094, doi: 10.3748/wjg.v24.i45.5081.Foerster F, Hoppe-Lotichius M, Vollmar J, Long-term observation of hepatocellular carcinoma recurrence after liver transplantation at a European transplantation centre, United European Gastroenterology Journal 2019, Vol. 7(6) 838–849, doi: 10.1177/205064061984022119.Foerster F, Hoppe-Lotichius M, Vollmar J, Long-term observation of hepatocellular carcinoma recurrence after liver transplantation at a European transplantation centre, United European Gastroenterology Journal 2019, Vol. 7(6) 838–849, doi: 10.1177/205064061984022119.Sapisochin G, Bruix J. Liver transplantation for hepatocellular carcinoma: outcomes and novel surgical approaches. Nat Rev Gastroenterol Hepatol. 2017 Apr;14(4):203-217. doi: 10.1038/nrgastro.2016.193.Sapisochin G, Bruix J. Liver transplantation for hepatocellular carcinoma: outcomes and novel surgical approaches. Nat Rev Gastroenterol Hepatol. 2017 Apr;14(4):203-217. doi: 10.1038/nrgastro.2016.193.Maccali C, Chagas AL, Boin I. Recurrence of Hepatocellular Carcinoma After Liver Transplantation: Prognostic and predictive factors of survival in a Latin American cohort, Liver Int. 2021 Apr;41(4):851-862. doi: 10.1111/liv.14736Maccali C, Chagas AL, Boin I. Recurrence of Hepatocellular Carcinoma After Liver Transplantation: Prognostic and predictive factors of survival in a Latin American cohort, Liver Int. 2021 Apr;41(4):851-862. doi: 10.1111/liv.14736Karakaya E, Akdur A, Soy EA. et al. Treatment of Posttransplant Hepatocellular Carcinoma Recurrence, Experimental and Clinical Transplantation (2022) 1:59-61 DOı: 10.6002/ect.2021.0450.Karakaya E, Akdur A, Soy EA. et al. Treatment of Posttransplant Hepatocellular Carcinoma Recurrence, Experimental and Clinical Transplantation (2022) 1:59-61 DOı: 10.6002/ect.2021.0450.Davis E, Wiesner R, Valdecasas J. et al: Treatment of recurrent hepatocellular carcinoma after liver transplantation. Liver Transpl, 2011; 17(Suppl. 2): S162–66, doi: 10.1002/lt.22361.Davis E, Wiesner R, Valdecasas J. et al: Treatment of recurrent hepatocellular carcinoma after liver transplantation. Liver Transpl, 2011; 17(Suppl. 2): S162–66, doi: 10.1002/lt.22361.de’Angelis N, Landi F, Carra MC, Azoulay D. Managements of recurrent hepatocellular carcinoma after liver transplantation: a systematic review. World J Gastroenterol. 2015;21(39):11185-98, doi: 10.3748/wjg.v21.i39.11185.de’Angelis N, Landi F, Carra MC, Azoulay D. Managements of recurrent hepatocellular carcinoma after liver transplantation: a systematic review. World J Gastroenterol. 2015;21(39):11185-98, doi: 10.3748/wjg.v21.i39.11185.Pomfret EA, Washburn K, Wald C. et al. Report of a national conference on liver allocation in patients with hepatocellular carcinoma in the United States. Liver Transpl. 2010;16(3):262-78, doi: 10.1002/lt.21999.Pomfret EA, Washburn K, Wald C. et al. Report of a national conference on liver allocation in patients with hepatocellular carcinoma in the United States. Liver Transpl. 2010;16(3):262-78, doi: 10.1002/lt.21999.Yao FY, Mehta N, Flemming J. et al. Downstaging of hepatocellular cancer before liver transplant: long-term outcome compared to tumors within Milan criteria. Hepatology. 2015;61(6):1968-77, doi: 10.1002/hep.27752Yao FY, Mehta N, Flemming J. et al. Downstaging of hepatocellular cancer before liver transplant: long-term outcome compared to tumors within Milan criteria. Hepatology. 2015;61(6):1968-77, doi: 10.1002/hep.27752Levi DM, Tzakis AG, Martin P, et al. Liver transplantation for hepatocellular carcinoma in the model for end-stage liver disease era. J Am Coll Surg. 2010;210(5):727-34, doi: 10.1016/j.jamcollsurg.2010.01.007.Levi DM, Tzakis AG, Martin P, et al. Liver transplantation for hepatocellular carcinoma in the model for end-stage liver disease era. J Am Coll Surg. 2010;210(5):727-34, doi: 10.1016/j.jamcollsurg.2010.01.007.Zheng J, Cai J, Tao L. et al. Comparison on the efficacy and prognosis of different strategies for intrahepatic recurrent hepatocellular carcinoma: A systematic review and Bayesian network meta-analysis, International Journal of Surgery 83 (2020) 196–204, doi: 10.1016/j.ijsu.2020.09.031.Zheng J, Cai J, Tao L. et al. Comparison on the efficacy and prognosis of different strategies for intrahepatic recurrent hepatocellular carcinoma: A systematic review and Bayesian network meta-analysis, International Journal of Surgery 83 (2020) 196–204, doi: 10.1016/j.ijsu.2020.09.031.Jeon MY, Kim HS, Lim TS. et al. Refractoriness to transarterial chemoembolization in patients with recurrent hepatocellular carcinoma after curative resection. PloS one. 2019;14(4):e0214613, doi: 10.1371/journal.pone.0214613.Jeon MY, Kim HS, Lim TS. et al. Refractoriness to transarterial chemoembolization in patients with recurrent hepatocellular carcinoma after curative resection. PloS one. 2019;14(4):e0214613, doi: 10.1371/journal.pone.0214613.Koh PS, Chan AC, Cheung TT. et al. Efficacy of radiofrequency ablation compared with transarterial chemoembolization for the treatment of recurrent hepatocellular carcinoma: a comparative survival analysis. HPB (Oxford). 2016;18(1):72–8, doi: 10.1016/j.hpb.2015.07.005.Koh PS, Chan AC, Cheung TT. et al. Efficacy of radiofrequency ablation compared with transarterial chemoembolization for the treatment of recurrent hepatocellular carcinoma: a comparative survival analysis. HPB (Oxford). 2016;18(1):72–8, doi: 10.1016/j.hpb.2015.07.005.Liu Y, Ren Y, Ge S. et al. Transarterial Chemoembolization in Treatment-Naïve and Recurrent Hepatocellular Carcinoma: A Propensity-Matched Outcome and Risk Signature Analysis. Frontiers in oncology. 2021;11:662408, doi: 10.3389/fonc.2021.662408.Liu Y, Ren Y, Ge S. et al. Transarterial Chemoembolization in Treatment-Naïve and Recurrent Hepatocellular Carcinoma: A Propensity-Matched Outcome and Risk Signature Analysis. Frontiers in oncology. 2021;11:662408, doi: 10.3389/fonc.2021.662408.Ko HK, Ko GY, Yoon HK, Sung KB. Tumor response to carcinoma after living donor liver transplantation. Korean J Radiol 2007; 8: 320-327, doi: 10.3348/kjr.2007.8.4.320.Ko HK, Ko GY, Yoon HK, Sung KB. Tumor response to carcinoma after living donor liver transplantation. Korean J Radiol 2007; 8: 320-327, doi: 10.3348/kjr.2007.8.4.320.Zhou B, Shan H, Zhu KS. et al. Chemoembolization with lobaplatin mixed with iodized oil for unresectable recurrent hepatocellular carcinoma after orthotopic liver transplantation. J Vasc Interv Radiol 2010; 21: 333-338, doi: 10.1016/j.jvir.2009.11.006Zhou B, Shan H, Zhu KS. et al. Chemoembolization with lobaplatin mixed with iodized oil for unresectable recurrent hepatocellular carcinoma after orthotopic liver transplantation. J Vasc Interv Radiol 2010; 21: 333-338, doi: 10.1016/j.jvir.2009.11.006Llovet JM, Real MI, Montana X. et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet. 2002; 359(9319):1734–9, doi: 10.1016/S0140-6736(02)08649-X.Llovet JM, Real MI, Montana X. et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet. 2002; 359(9319):1734–9, doi: 10.1016/S0140-6736(02)08649-X.Bruix J, Reig M, Sherman M. Evidence-Based Diagnosis, Staging, and Treatment of Patients With Hepatocellular Carcinoma. Gastroenterology. 2016 Apr;150(4):835-53. doi: 10.1053/j.gastro.2015.12.041.Bruix J, Reig M, Sherman M. Evidence-Based Diagnosis, Staging, and Treatment of Patients With Hepatocellular Carcinoma. Gastroenterology. 2016 Apr;150(4):835-53. doi: 10.1053/j.gastro.2015.12.041.Bruix J, Takayama T, Mazzaferro V. et al. Adjuvant sorafenib for hepatocellular carcinoma after resection or ablation (STORM): a phase 3, randomised, double-blind, placebo-controlled trial. Lancet Oncol. 2015; 16(13):1344–54, doi: 10.1016/S1470-2045(15)00198-9.Bruix J, Takayama T, Mazzaferro V. et al. Adjuvant sorafenib for hepatocellular carcinoma after resection or ablation (STORM): a phase 3, randomised, double-blind, placebo-controlled trial. Lancet Oncol. 2015; 16(13):1344–54, doi: 10.1016/S1470-2045(15)00198-9.Huang J, Yan L, Cheng Z. et al. A randomized trial comparing radiofrequency ablation and surgical resection for HCC conforming to the Milan criteria. Annals of surgery. 2010; 252(6):903–12, doi: 10.1097/SLA.0b013e3181efc656.Huang J, Yan L, Cheng Z. et al. A randomized trial comparing radiofrequency ablation and surgical resection for HCC conforming to the Milan criteria. Annals of surgery. 2010; 252(6):903–12, doi: 10.1097/SLA.0b013e3181efc656.Shim JH, Kim KM. et al. Complete necrosis after transarterial chemoembolization could predict prolonged survival in patients with recurrent intrahepatic hepatocellular carcinoma after curative resection. Ann Surg Oncol. 2010;17(3):869–77, doi: 10.1245/s10434-009-0788-7.Shim JH, Kim KM. et al. Complete necrosis after transarterial chemoembolization could predict prolonged survival in patients with recurrent intrahepatic hepatocellular carcinoma after curative resection. Ann Surg Oncol. 2010;17(3):869–77, doi: 10.1245/s10434-009-0788-7.Kim DS, Lim TS, Jeon MY. et al. Transarterial Chemoembolization in Treatment-Naïve and Recurrent Hepatocellular Carcinoma: A Propensity-Matched Outcome Analysis. Dig Dis Sci.2019;64(12):3660–8, doi: 10.1007/s10620-019-05701-8.Kim DS, Lim TS, Jeon MY. et al. Transarterial Chemoembolization in Treatment-Naïve and Recurrent Hepatocellular Carcinoma: A Propensity-Matched Outcome Analysis. Dig Dis Sci.2019;64(12):3660–8, doi: 10.1007/s10620-019-05701-8.Sapisochin G, Goldaracena N, Astete S. et al. Benefit of treating hepatocellular carcinoma recurrence after liver transplantation and analysis of prognostic factors for survival in a large Euro-American Series. Ann Surg Oncol. 2015;22(7):2286-2294, doi: 10.1245/s10434-014-4273-6.Sapisochin G, Goldaracena N, Astete S. et al. Benefit of treating hepatocellular carcinoma recurrence after liver transplantation and analysis of prognostic factors for survival in a large Euro-American Series. Ann Surg Oncol. 2015;22(7):2286-2294, doi: 10.1245/s10434-014-4273-6.

The authors declare that there are no conflicts of interest present.