VCU news

By Lorraine Cichowski and Robert Fisher

RICHMOND, Va. – A multi-part therapy that combines radiofrequency ablation, chemotherapy and liver transplant has dramatically increased survival rates for patients with liver cancer, according to a five-year study at the Virginia Commonwealth University Medical Center.

 

An abstract of the study, presented Sunday (June 1) at the American Transplantation Congress 2003 in Washington, D.C., showed an 84.8 percent survival rate for patients with cirrhosis and primary liver cancer who were treated with the multi-modality therapy between January 1998 and February 2003 at VCU’s Hume-Lee Transplant Center. The survival rate is especially noteworthy because five-year survival rates in the United States for primary liver cancer, as reported by the National Cancer Institute, generally are very low – less than 10 percent.

 

“What used to be a death sentence for patients with primary liver cancer now is a long-term survival by treating them with radiofrequency ablation and ablative chemotherapy before a liver transplant,” said Dr. Robert A. Fisher, professor and director of VCU’s Liver Transplant Program and Transplant Research Laboratories. “That’s very remarkable.”

 

Primary liver cancer, also known as hepatocellular carcinoma (HCC), is one of the most common malignancies in the world. Although it once was rare in the United States, liver cancer now is occurring at a greater frequency as the number of Americans with hepatitis C ages. According to Fisher, four or five new liver cancer patients come to the Hume-Lee Transplant Clinic in an average month now versus one or two every few months before 1998.

 

A small number of patients with small liver tumors and very early cirrhosis can be treated with surgery. Curing more extensive liver cirrhosis and select liver cancers requires a liver transplant, which can mean a wait of as long as 18 months because of organ shortages. During that period, some patients might die; in others, the cancer might worsen or spread, making the patient ineligible for a transplant. Physicians, therefore, are looking for ways to slow the cancer progression and shorten transplant waiting times.  

 

The VCU study included 33 patients – 29 men and four women -- with cirrhosis and cancer confined to the liver who were candidates for liver transplants. The patients were treated aggressively with an average of 2.9 procedures that included chemotherapy and radiofrequency ablation, in which radiofrequency energy is injected into a tumor through a needle to heat and destroy cancerous tissue. The patients were monitored and sometimes retreated until a liver from a deceased person became available for transplant or when a live donor was willing to donate a right liver lobe.  The average wait for a liver was seven months.

 

Although “dropout” rates from the liver transplant list in patients with cirrhosis and HCC traditionally have been as high as 40 percent because of cancer progression, spread or death of the patient, the VCU study showed a “dropout” rate of only 9 percent at six and 12 months after a patient entered the treatment and 15 percent at 24 months – for a total of 5 dropouts from the original 33 patients. No case of dropout was reported after two years.  Of the 28 patients remaining in the study, 26 had had transplants by the end of the study in February, and two still were waiting.

 

“Multi-modality therapy allowed us to reduce the dropout rate in cirrhotic patients with primary liver cancer without losing the more than 95 percent, three-year cancer-free survival advantage to these transplanted patients,” said Dr. Daniel G. Maluf, assistant professor in VCU’s Division of Transplantation Surgery.

 

Fisher’s VCU liver cancer molecular group, working in collaboration with a team from the National Cancer Institute’s virology epidemiology branch, this week also received approval from the National Institutes of Health to study gene changes in liver cancer formation. The new grant will allow researchers to attempt to identify the genes in patients with hepatitis C that causes primary liver cancer to recur. The project supports VCU’s $1.5 million NIH award to study outcomes of liver transplant patients as part of the NIH’s Adult-to-Adult Living Donor Liver Transplant Cohort Study.

 

VCU’s Hume-Lee Transplant Center is one of the oldest, continuously active transplant programs in the United States and consistently is ranked among the busiest, most innovative and clinically successful programs in the nation. Virginia’s first kidney transplant was performed at the center, and Hume-Lee was one of the pioneering centers in the United States to perform an adult-to-adult living donor liver transplant. The multi-disciplinary transplant team includes internationally recognized transplant surgeons, transplant hepatologists, molecular biologists and specialists in bioinformatics.