Shrinking liver cancer tumors before transplant yields excellent outcomes, researchers report

Medical Xpress / The Mount Sinai Hospital / ^

[ConservativeMind]

Treating liver cancer tumors to shrink them in order to allow the patient to qualify for a liver transplant leads to excellent 10-year post-transplant outcomes, according to research. The results validate current national policies around transplant eligibility.

Selection of patients with hepatocellular carcinoma (HCC), the most common form of liver cancer, for transplant has been guided for more than two decades by standards known as the Milan criteria. The Milan criteria state that transplantation should be performed in those with a single tumor of five centimeters or less in diameter or three tumors that are each three centimeters or less in diameter, have no macrovascular invasion, and no metastasis.

One aspect of the current criteria is known as downstaging: the process of applying liver directed therapy to tumors too big for the Milan criteria with the hope of reducing them to the suggested size. Downstaging is now an option in selecting suitable liver transplant candidates with initial tumors that exceed the criteria. However, liver cancer can recur after transplantation, either within the liver or outside of the liver. The treatment options of patients who have recurrence post transplantation is limited and prognosis is poor.

The 10-year post-transplant survival and recurrence rates were, respectively, 52.1% and 20.6% among those whose disease was downstaged; 61.5% and 13.3% in those always within the criteria; and 43.3% and 41.1% in those whose disease was not downstaged.

"Our study represents a solid confirmation that HCC patients effectively downstaged to Milan criteria have an outstanding median survival of 10 years, thus providing the rationale to adopt this policy on a global basis," said Josep Llovet, MD, Ph.D. "With this study clinical practice guidelines of management of HCC can recommend our approach with an acceptable level of evidence."

[ConservativeMind]

Reducing cancer in an organ that will still be removed appears to help the replacement have less chance of having problems.

[ConservativeMind]

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[pfflier]

I have a friend that had exactly this happen to him. Stage III tumor. They implanted a radioactive bead next to the tumor and it disappeared. He got his transplant about a month ago and is doing well.

A few short years ago, this would have been a death sentence.

[boop]

I too have a friend undergoing this bead treatment right now. His daughter is going to donate a portion of her liver to transplant.

[pfflier]

I wish them the best.

This treatment worked better than anybody's wildest expectation, even the doctors were surprised. The whole tumor was gone. He was stage zero when they did the transplant.

The daughter will donate about 1/3 of her liver which will regenerate completely in a few months. Her dad will grow a complete liver in about the same amount of time. Amazing organ.