Aggressive cutaneous malignancies following cardiothoracic transplantation: the Australian experience.
BACKGROUND
The development of malignancies in recipients of a cardiothoracic transplant (CTT)--that is, heart, lung, or heart and lung recipients-is of concern. Cutaneous and lymphoproliferative malignancies comprise the two major groups of malignancies encountered. A small subgroup of patients will develop potentially life-threatening aggressive cutaneous malignancies (ACM); these are poorly defined and documented in the literature. The authors report the results for 619 CTT recipients from a single institution.


METHODS
Between 1984 and 1995, 619 recipients received a CTT. With a minimum follow-up of 2 years, 66 patients (10.7%) were diagnosed with a major malignancy, and 27 of these 66 patients developed ACM. ACM were defined as having one or more of the following characteristics: local invasion and/or regional metastases at diagnosis, poor differentiation, and locoregional and/or systemic relapse following therapy. All malignant melanomas were considered ACM. Data on malignancy occurrence were documented in the clinical notes of the heart and lung transplant unit. A retrospective analysis was undertaken from these notes.


RESULTS
Tumor histology was predominantly poorly differentiated squamous cell carcinoma (55%) (SCC) and malignant melanoma (30%) (MM). No patient developed Kaposi sarcoma (KS). The median time from transplant to diagnosis of ACM was 52 months (range, 8-127 months). Thirteen of 27 patients have died; 10 of them died of metastatic disease. The mean time to death was 20 months (range, 8-54 months). Of 14 patients alive, 5 have disease. All but one of the 19 patients diagnosed with nonmelanoma ACM received radiotherapy, either as part of initial treatment or on relapse. Eight patients have subsequently suffered an infield relapse.


CONCLUSIONS
The development of ACM in CTT recipients resulted in substantial morbidity and mortality. Poor results were obtained with standard surgery and radiotherapy. Treatment modalities for and the underlying pathobiology of ACM in organ transplant recipients require detailed research if improved outcomes are to be achieved.
Veness
M J
MJ
Department of Radiation Oncology, Westmead Hospital, Sydney, NSW, Australia.
Quinn
D I
DI
Ong
C S
CS
Keogh
A M
AM
Macdonald
P S
PS
Cooper
S G
SG
Morgan
G W
GW
D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D006258:Head and Neck Neoplasms / Q000453:epidemiology / Q000209:etiology / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D016027:Heart Transplantation; D016041:Heart-Lung Transplantation; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016040:Lung Transplantation; D008297:Male; D008545:Melanoma / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology / Q000209:etiology / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
D007166:Immunosuppressive Agents