Navigation Links
New transplantation criteria for liver cancer patients
Date:7/28/2010

Researchers at the University of California, San Francisco propose that treatments used on liver cancers beyond the established Milan criteria for liver transplantation may be appropriate for all patients with hepatocellular carcinoma (HCC) who are listed for transplantation. Full details appear in the August issue of Liver Transplantation, a journal published by Wiley-Blackwell on behalf of the American Association for the Study of Liver Diseases (AASLD).

According to the American Cancer Society, about 90% of adult primary liver cancers are hepatocellular carcinomas. In 2009, an estimated 22,620 adults in the U.S. were diagnosed with primary liver cancer with 18,160 deaths expected to occur this year from HCC. Liver cancer is the sixth most common cause of cancer death among men, and ninth most common cause of cancer death among women.

Liver transplantation is an important treatment option for selected patients with non-resectable HCC. The Milan criteria provide guidelines to qualify 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. The Milan criteria were adopted because it identified a population with excellent outcome potential following transplantationroughly equivalent to patients transplanted without HCC. However, HCC incidence is expected to increase and researchers are investigating whether the criteria for liver transplantation should be expanded to make even more patients eligible.

The San Francisco researchers suggest that the Milan and other criteria have proved inadequate. Team leader Dr. John Roberts explains, "It has not been shown there is any particular size of tumor that represents a 'no risk' of recurrence, at least among those tumors that can be detected radiologically. Further, the degree of risk is not the same for all patients within the Milan criteria."

Dr. Roberts points out that tumor size and number are only surrogate markers for underlying tumor biology and that using another markertumor behavior over timeallows the biology of the tumor to become apparent, dictating the most appropriate treatment strategy.

The UCSF team has taken a 'down staging' approach for patients with large tumors. This involves 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 extra-hepatic or intra-hepatic spread is observed. This paradigm results 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 as compared to patients transplanted with tumors beyond the Milan criteria who are not treated. The median time between the first ablative procedure and transplantation was 8.2 months with a range of 3-25 months. This approach suggests that the test of time may be the surest method to select patients with HCC who are destined to have good transplant outcomes. Dr. Roberts argues that this approach, ablating the tumor and waiting, should be expanded to all patients listed for transplantation with hepatocellular carcinoma 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."


'/>"/>

Contact: Dawn Peters
healthnews@wiley.com
781-388-8408
Wiley-Blackwell
Source:Eurekalert

Related medicine news :

1. Stem cell transplantation of therapy-resistant chronic leukemia successful
2. Combination of Meniscus Allograft Transplantation and Repair of Articular Cartilage May Slow the Progression of Arthritis in the Knee
3. The experience of arterial reconstruction in adult-to-adult living donor liver transplantation
4. African-Americans and women are less likely to undergo bone marrow transplantation
5. Study examines global availability of treatment involving transplantation of blood stem cells
6. Cedars-Sinai heart transplantation tip sheet
7. Cell Transplantation Eyed as Treatment for Cerebral Palsy
8. Living donor exchange poses new option for liver transplantation
9. Novel Parkinson's Treatment Strategy Involves Cell Transplantation
10. Fewer platelets could be used for some cancer and bone-marrow transplantation patients
11. New Criteria for Alzheimers Diagnosis Proposed
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:2/7/2016)... ... February 07, 2016 , ... HealthSmart Holdings, ... and organizations with the tools and information to lower the costs, and increase ... the cost of providing employee healthcare benefits by as much as 22%:, + ...
(Date:2/7/2016)... Scottsdale, AZ (PRWEB) , ... February 07, 2016 ... ... & Neck and Facial Plastics, has added Kybella® to his medical and surgical ... is a newly approved FDA injectable medication used as a non-surgical alternative for ...
(Date:2/6/2016)... , ... February 06, 2016 ... ... 303-368-6225 , MEDIA ADVISORY: 5000 PERIOPERATIVE NURSES EXPECTED AT AORN SURGICAL CONFERENCE ... perioperative nurses in the world with an estimated 5000 perioperative nurses in ...
(Date:2/6/2016)... ... February 06, 2016 , ... US Sports Camps is ... (YUCC) . This event brings together top non-profit leaders, ultimate organizations, and coaches from ... Ultimate”. Valerio Iani, Bay Area Disc Program Director of Youth and Education, describes this ...
(Date:2/6/2016)... Viejo, CA (PRWEB) , ... February 06, 2016 , ... ... quickly and easily add warm color grades to their footage. A LUT is a ... every pixel's color to the corresponding color indicated by the table. By manipulating each ...
Breaking Medicine News(10 mins):
(Date:2/5/2016)... , Feb. 5, 2016  Patients in Alabama ... focused ultrasound (HIFU) therapy no longer have to travel out ... its partnership with Urology Centers of Alabama to ... FDA-cleared procedure for qualifying patients. Alabama ... in the treatment of prostate cancer using many different modalities. ...
(Date:2/5/2016)... 5, 2016 Aethlon Medical, Inc. (Nasdaq: AEMD ... CEO, will be presenting at Source Capital Group,s 2016 Disruptive ... at 2:15 p.m. ET on Wednesday, February 10, ... discussion taking place at 3:15 p.m. ET. http://www.aethlonmedical.com ... hour after the conclusion of the live event. The panel ...
(Date:2/5/2016)... 5, 2016 Dehaier Medical Systems Ltd. ... "Company"), which develops, markets and sells medical devices ... China and international markets, today announced ... to concentrate the Company,s resources to develop its ... and to focus more on its major businesses. ...
Breaking Medicine Technology: