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Tumor Response May Determine Best Liver Transplant Candidates
by: Robert Preidt

In liver cancer patients, the effectiveness of treatment to reduce tumor size may be a better way of determining a patient's eligibility for transplant than the traditional method of assessing the size and number of tumors, also known as the Milan criteria, a new study says.

Liver transplantation is considered an effective treatment for early-stage hepatocellular carcinoma (HCC). Tumors are treated in order to bridge the waiting time before a liver becomes available for transplant. There's been little research on whether this treatment may have an effect on transplant patient survival.

This study included 96 HCC patients who received periodic transarterial chemoembolization (TACE) prior to having a liver transplant. The TACE treatment -- designed to halt or slow tumor growth -- was repeated every six weeks and every time the patients had a CT scan to assess tumor growth.

Of these 96 patients, 16 met the Milan criteria and were immediately put on the transplant list, while 34 other patients initially exceeded the Milan criteria but responded to TACE and were placed on the transplant list.

After five years, 94 percent of the patients in the first group had no cancer recurrence, compared to 75 percent of patients in the second group.

Since there wasn't a significant difference between the two groups, the findings suggest that the Milan criteria may not be crucial in predicting cancer recurrence following liver transplant, conclude the team from Johannes Gutenberg University in Mainz, Germany.

"Our study suggests that oncological control reached by the scheduled TACE pretreatment during the waiting time is obviously of greater importance for the long-term prognosis than downstaging (reducing tumor size) itself," the study authors wrote.

The study was published in the August issue of Liver Transplantation.

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