Ablation followed by observation improves outcomes of HCC patients undergoing transplant

-- Beth Gilbert

Friday, July 30, 2010 (Last Updated: 08/02/2010)

FRIDAY, July 30 (HealthDay News) -- The use of tumor ablation followed by a period of observation for all patients with hepatocellular carcinoma (HCC) listed for transplant may be an effective strategy, as it may eliminate patients whose disease is likely to recur after transplantation, according to an opinion piece published online July 23 in Liver Transplantation.

John P. Roberts, M.D., of the University of California in San Francisco, and colleagues write of the "ablate and wait" strategy for improving the five-year recurrence-free outcome of liver transplantation in patients with HCC compared to rapid transplantation. The researchers looked at extending the Milan criteria, which are guidelines used to qualify HCC patients for liver transplantation based on tumor size and the lack of extrahepatic manifestations and vascular invasion.

The researchers write that using "downstaging," which involves radiofrequency ablation, chemoembolization, or both, and a period of waiting, for patients with a tumor burden outside the Milan criteria who make it to transplantation results in excellent outcomes. These outcomes rival those of patients who undergo transplantation within the Milan criteria, with approximately 30 percent of patients being excluded from liver transplantation due to HCC progression, according to the researchers. In addition, the median time between the first ablative procedure and transplantation was 8.2 months with a range of three to 25 months.

"This experience has led to two conclusions: first, expansion beyond the Milan criteria should not occur without therapy directed to the tumor followed by a period of waiting to decrease the risk of recurrence, and second, for tumors within the Milan criteria, the same strategy should be considered," the authors write.

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Specialties Gastroenterology
Hematology & Oncology

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