Table 1.
Studies of downstaging therapy for hepatic resection of HCC.
| Study | Year | Intervention | Types of intervention | N of receiving downstaging | Design | Reason of unresectability |
|---|---|---|---|---|---|---|
| Sitzmann (19) | 1993 | Combined RT and CT | LRT+systemic treatment | 14 | Retrospective cohort | Extrahepatic metastasis; diffuse liver tumor or major vascular invasion |
| Majno (20) | 1997 | TACE | LRT | 49 | Case series | Three or more intrahepatic tumor nodules |
| Fan (21) | 1998 | TACE | LRT | 65 | Case series | Too bulky for resection or situated centrally at the hepatic hilus |
| Lau2 (22) | 2001 | Chemoimmunotherapy | Systemic treatment | 150 | Case series | Extrahepatic metastasis; diffuse liver tumor or major vascular invasion |
| Clavien (23) | 2002 | CT | Systemic treatment | 28* | Prospective pilot study | Diffuse liver tumor; large solitary tumor or major vascular invasion |
| Lau1 (24) | 2004 | SIR/CT | LRT/systemic treatment | 71 (SIR) | Case series | Extrahepatic metastasis; diffuse liver tumor or major vascular invasion |
| 124 (PAIF) | ||||||
| 75 (doxorubicin) | ||||||
| Tang (25) | 2004 | Multimodality | LRT | 379 (HAI) | Case series | NA |
| 1085 (HAI+HAL) | ||||||
| 562 (HAI+HAL+RAIT) | ||||||
| Zhao (26) | 2009 | TACE or TACE+PEI or TACE-RT | LRT | 34 | Case series | Too bulky for resection; diffuse liver tumor or major vascular invasion |
| Shi (27) | 2012 | TACE | LRT | 412 | Case series | Too bulky for resection or located centrally at the hepatic hilus |
| Chen (28) | 2013 | TACE | LRT | 433 | Case series | NA |
| Kaseb (29) | 2013 | CT (mPAIF vs. PAIF) | Systemic treatment | 117 (33 vs. 84) | Retrospective cohort | Extrahepatic metastasis; diffuse liver tumor or major vascular invasion |
| Lee1 (30) | 2014 | HAI+CCRT followed by resection vs. HAI+CCRT alone | LRT | 243 (41 vs. 202) | Retrospective cohort | Too bulky for resection; diffuse liver tumor or major vascular invasion |
| Lee2 (31) | 2014 | CCRT | LRT | 41 | Retrospective cohort | Too bulky for resection; major vascular invasion |
| Zhang (32) | 2016 | TACE-RT | LRT | 82 (43 vs. 39) | Retrospective cohort | NA |
| Li (33) | 2017 | TACE+sorafinib | LRT+systemic treatment | 21 | Case series | BCLC stage B-C |
| Hamaoka (34) | 2017 | HAI+RT followed by resection vs. HAI+RT alone | LRT | 50 (7 vs. 43) | Retrospective cohort | HCC with PVTT |
| He (35) | 2018 | HAI+sorafenib | LRT+systemic treatment | 35 | Prospective single-arm | Extrahepatic metastasis; HCC with PVTT |
| Lee3 (36) | 2019 | HAI | LRT | 103 | Case series | Extrahepatic metastasis; diffuse liver tumor or major vascular invasion |
| Goto (37) | 2020 | HAI | LRT | 18 | Retrospective cohort | Diffuse liver tumor or major vascular invasion |
| Chiu (38) | 2020 | DEB-TACE vs. cTACE | LRT | 61(42 vs. 19) | Retrospective cohort | Diffuse liver tumor or major vascular invasion |
N, number of patients; NA, not available; RT, radiotherapy; CT, chemotherapy; TACE, transarterial chemoembolization; SIR, selective internal radiation; PAIF, cisplatin, doxorubicin, 5-fluorouracil, and interferon-alpha; HAI, hepatic arterial infusion; PEI, percutaneous ethanol injection; RAIT, radioimmunotherapy; mPAIF, modified PAIF; BCLC, Barcelona Clinic Liver Cancer; DEB-TACE, drug-eluting beads transarterial chemoembolization; cTACE, conventional transarterial chemoembolization.
*5 HCC and 23 metastatic colorectal cancer.