For patients with liver cancer (too known as hepatocellular carcinoma), transplantation has been qualified to those who accommodate the Milan criteria. Their tumors must involve one lesion less than or equal to five centimeters in diameter, or two to leash lesions each less than or rival to troika centimeters. However, studies have suggested that patients with slightly larger lesions may also do well with a transplant.
Rather than extend the Milan criteria, researchers have suggested down-staging hepatocellular carcinoma to select for tumors with more well-disposed biology that will respond to discussion and do well following liver transplant. The shock of successful down-staging on post-transplant outcomes was thus far unknown.
Researchers, lED by Francis Yao of the University of California at San Francisco, conducted a prospective study of down-staging protocol and report intention-to-treat endurance, dropout and post-transplant neoplasm recurrence, along with factors that whitethorn influence response to down-staging treatment.
Between June 2002 and January 2007, the researchers enrolled 61 liver crab patients whose tumor stage exceeded the Milan criteria. Fifty-five of these patients received a combination of laparoscopic radiofrequency ablation (RFA) and transarterial chemoembolization (TACE). The leftover 6 patients underwent resection as the down-staging procedure.
Down-staging was successful in 43 of the 61 patients (70.5 percent), and 35 of those received a liver transplant later on a medial of 8.2 months. While deuce of the transplant recipients died (1 from graft problems and the other from recurrent hepatitis C infection), the remaining 33 were live and justify of liver cancer return after a median follow-up of 25 months.
In the patients for whom down-staging was abortive, 15 had tumor progression, while 3 died (deuce related to the down-staging, the other not.)
Comparing the clinical characteristics of the 35 patients who received a liver transplant to the 18 patients with treatment failure, only average alpha fetoprotein (AFP) degree was significantly different. Treatment failure was the eventual outcome in seven of the eighter from Decatur patients with pre-treatment AFP > 1000 ng/mL. "High AFP may be a marker for vascular invasion or extra-hepatic disease that escapes detection by conventional mental imagery techniques," the authors suggest.
The authors line the heterogeneousness of they loco-regional therapy may be a weakness of their study, and that the optimal handling should be determined on a individual basis. They also point out that 25 months of post-transplant follow-up may be overly short to fully determine the peril of liver cancer recurrence.
Still, they conclude, "our results suggest that tumor down-staging to get together conventional criteria for orthotopic liver transplant (OLT) among carefully selected patients is associated with excellent post-transplant outcome. Down-staging put selection pressure against aggressive tumors that are likely to progress contempt treatment, whereas tumors with more favorable histology are more potential to respond to discourse and do well after OLT."
They call for further studies to refine down-staging treatment strategies to ameliorate the intention-to-treat outcome.
Article: "Excellent outcome following down-staging of hepatocellular carcinoma prior to liver transplantation: An intention-to-treat analysis." Yao, Francis; Kerlan, Robert; Hirose, Ryutaro; Davern, Timothy; Bass, Nathan; Feng, Sandy; Peters, Marion; Terrault, Norah; Freise, Chris; Ascher, Nancy; Roberts, John. Hepatology; September 2008; 10.1002/hep.22412.
Source: Sean Wagner
Wiley-Blackwell
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