Better Outcomes with Liver Transplant for Hilar Cholangiocarcinoma Patients
For patients with localized, node-negative hilar cholangiocarcinoma, liver transplantation preceded by radiation and chemotherapy may be an alternative to surgical resection, according to a study published in the Annals of Surgery.
The liver is a large organ located in the upper abdomen that aids in digestion and removes waste products from the blood. Liver cancer is categorized into different types according to the area of the liver in which the cancer began. Cholangiocarcinoma is a type of liver cancer that develops in the bile ducts-the small tubes that carry bile (a substance that aids in the digestion of fats) from the liver to the intestine. Cholangiocarcinoma that develops where the left and right bile ducts meet is called hilar cholangiocarcinoma. Many people with cholangiocarcinoma also suffer from primary sclerosing cholangitis (PSC), an inflammation of the bile ducts of unknown cause.
Hilar cholangiocarcinoma may be treated by surgical removal of the cancer (resection) in some patients. However, patients with extensive disease within the liver may not be candidates for resection. In 1993, researchers at the Mayo Clinic developed a treatment protocol for patients with unresectable cancer that involved radiation therapy and chemotherapy, followed by liver transplantation. Patients with underlying PSC were also treated with this protocol. Only patients with stage I or stage II cholangiocarcinoma were candidates for liver transplantation.
In order to assess patient outcomes after treatment with resection or the liver transplant protocol, the researchers evaluated data from patients who were treated at the Mayo Clinic between 1993 and 2004. During these years, 71 patients were identified as candidates for liver transplantation, and 38 (54%) of these patients received a liver transplant. Reasons for not receiving a liver transplant included death, disease progression, surgical evidence of disease that was too extensive for the transplant protocol, or no available donor liver (patient still on waiting list). Among all 71 initial candidates for liver transplantation, 79% survived for at least one year and 58% survived for at least 5 years. Among the 38 patients who received a liver transplant, 92% survived for at least one year and 82% survived for at least five years. After five years, 12% of liver transplant patients had developed a cancer recurrence.
Fifty-four patients had an attempted resection. Twenty-six (48%) of these patients actually underwent resection, and removal of the cancer appeared to be complete in 23 of the 26 patients. The remaining patients were found by surgery to have unresectable cancer. Of the 26 patients who underwent resection, 82% survived for at least one year and 21% survived for at least 5 years. After five years, 58% of patients treated with resection had developed a cancer recurrence.
The researchers conclude that for patients with localized, node-negative hilar cholangiocarcinoma, survival was significantly better after liver transplantation preceded by radiation and chemotherapy than after resection. Patients who had a liver transplant were also less likely to have a cancer recurrence than patients treated with resection. Liver transplantation may be an alternative to resection for some patients with hilar cholangiocarcinoma.
Reference: Rea DJ, Heimbach JK, Rosen CB et al. Liver transplantation with neoadjuvant chemoradiation is more effective than resection for hilar cholangiocarcinoma. Annals of Surgery. 2005;242:451-461.