Neoadjuvant chemotherapy and liver transplantation for hepatocellular carcinoma: a pilot study in 20 patients

• Published in: Gastroenterology (New York, N.Y. 1943) Vol. 104; no. 1; p. 196
• Main Authors: Stone, M J, Klintmalm, G B, Polter, D, Husberg, B S, Mennel, R G, Ramsay, M A, Flemens, E R, Goldstein, R M
• Format: Journal Article
• Language: English
• Published: United States 01.01.1993
• Subjects: Adult; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - therapy; Chemotherapy, Adjuvant; Combined Modality Therapy; Doxorubicin - adverse effects; Doxorubicin - therapeutic use; Female; Humans; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - therapy; Liver Transplantation; Male; Middle Aged; Neoplasm Recurrence, Local; Pilot Projects; Survival Analysis
• ISSN: 0016-5085
• DOI: 10.1016/0016-5085(93)90852-4

Liver transplantation for unresectable hepatocellular carcinoma yields disappointing results. Most cases recur within 2 years, often in the transplanted liver. A combination of neoadjuvant doxorubicin and orthotopic liver transplantation was used in 20 patients with unresectable hepatocellular carcinoma confined to the liver. Seventeen patients had tumors > 5 cm in greatest diameter, and 11 cases were stage IVA by the TNM classification. Doxorubicin was administered preoperatively, intraoperatively, and postoperatively at a dose of 10 mg/m2 weekly, totaling 200 mg/m2. Chemotherapy was well tolerated although leukopenia was observed in 70% of patients. Eight patients died, five of recurrent tumor and three of hepatitis B. Three others remain alive 8-22 months after tumor recurrence. One patient had initial tumor recurrence in the allograft. Actuarial survival is 59% and tumor-free survival is 54% at 3 years. For the 17 patients with tumors > 5 cm, overall survival is 63% and tumor-free survival is 49% at 3 years. The results of this pilot study suggest that neoadjuvant doxorubicin chemotherapy favorably alters the post-transplant survival of patients with hepatocellular carcinoma.