title: Usefulness of chemotherapy as prophylaxis of tumor recurrence after liver transplantation in advanced hepatocellular carcinomas.
abstract: BACKGROUND
  The effectiveness of chemotherapy as prophylaxis of tumor recurrence after liver transplantation in patients with advanced hepatocellular carcinoma is controversial.
  
  
  OBJECTIVE
  Our goal was to assess the outcomes of patients with advanced hepatocellular carcinoma treated with chemotherapy after liver transplant.
  
  
  METHODS
  Ten patients with liver transplants performed between 1993-2002 were men of mean age 55 years. The etiology of cirrhosis was hepatitis C in four patients, alcoholic cirrhosis in four, and cryptogenic cirrhosis in two. Immunosuppressive therapy was cyclosporine in five patients and tacrolimus in five. The chemotherapy regimen used adriamycin (20 mg/m2 weekly for 20 weeks). Six patients were stage IVA and four stage III. Hepatocellular carcinoma was known in five patients and incidental in the other five. Pathology revealed well-differentiated hepatocellular carcinoma in six patients and moderately differentiated hepatocellular carcinoma in four. Five patients had vascular invasion.
  
  
  RESULTS
  After a mean posttransplant follow-up of 28 months, six patients (60%) were alive without tumor recurrence, three (30%) had died from tumor recurrence and one due to P. carinii pneumonia. Disease-free survival among patients with stage III was 50% and 80% for stage IVA. Three patients with vascular invasion died of tumor recurrence, and the other two are alive and free of disease. Disease-free survival rates were 83% in patients with well-differentiated hepatocellular carcinoma and 25% in those with moderately differentiated hepatocellular carcinoma. Tolerance of chemotherapy was good with two withdrawals due to nephrotoxicity and myelotoxicity and one death from pneumonia.
  
  
  CONCLUSIONS
  The use of adriamycin in patients undergoing liver transplant due to advanced hepatocellular carcinoma may be useful to prevent tumor recurrence; it is well tolerated. The presence of vascular tumor invasion and a lower grade of histologic differentiation were associated with a poor prognosis.
authors.affiliation: Liver Transplantation Unit, Hospital Universitario Puerta de Hierro, Universidad Autónoma, Madrid, Spain.
authors.forename: N J
authors.initials: NJ
authors.lastname: De la Revilla
authors.forename: J M
authors.initials: JM
authors.lastname: Moreno
authors.forename: E
authors.initials: E
authors.lastname: Rubio
authors.forename: T A
authors.initials: TA
authors.lastname: de Herreros
authors.forename: E
authors.initials: E
authors.lastname: Navarrete
authors.forename: M J
authors.initials: MJ
authors.lastname: Lopez
authors.forename: V S
authors.initials: VS
authors.lastname: Turrion
authors.forename: M
authors.initials: M
authors.lastname: Jimenez
authors.forename: M
authors.initials: M
authors.lastname: Lucena
authors.forename: V
authors.initials: V
authors.lastname: Cuervas-Mons
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D004317:Doxorubicin / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation / Q000276:immunology / Q000401:mortality / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents; D004317:Doxorubicin