Treatment beyond liver transplantation criteria may improve patient outcomes

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Patients with liver cancer may benefit from treatment beyond transplantation criteria, according to a study published in Liver Transplantation (2010 Aug;16(8):925-9).

The study, led by researchers at the University of California, San Francisco, investigated a “down-staging” approach for patients with large tumors because they believed that the Milan and other transplantation criteria for liver cancer patients had proved inadequate.

According to background information provided in the press release announcing the findings, the Milan criteria provide guidelines to qualify hepatocellular carcinoma (HCC) patients for liver transplantation and include one tumor smaller than 5 cm or up to 3 tumors smaller than 3 cm, no extrahepatic manifestations, and no vascular invasion.

Researchers looked at a new approach which involved radiofrequency ablation, chemoembolization or both to control the tumor and then a requisite waiting period to determine tumor biology over time as the development of extrahepatic or intra-hepatic spread was observed.

Results of the study revealed that the approach resulted in about 30% of the patients being ineligible for transplantation because of HCC progression, but those who make it to transplantation have an excellent outcome compared to patients transplanted with tumors beyond the Milan criteria who are not treated.

Team leader Dr. John Roberts argued that the new approach, ablating the tumor and waiting, should be expanded to all patients listed for transplantation with HCC as the test of time can eliminate from transplantation patients whose disease is likely to recur after transplantation.

“Our experience with ablative treatment and then observation suggests that the ultimate outcomes of transplantation are not dependent on the primary tumor but more on time spent waiting for transplantation,” Dr. Roberts concluded. “It would seem logical that smaller and/or fewer tumors, though more unlikely to have spread, would also benefit from a period of time if the primary tumor can be controlled. The waiting period may be able to decrease the 10% recurrence rate seen in patients transplanted within Milan.”

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