title: Multimodality therapy and liver transplantation for hepatocellular carcinoma: a 14-year prospective analysis of outcomes.
abstract: BACKGROUND
  Hepatocellular carcinoma is a major cause of death among patients with cirrhosis. A standardized approach of multimodality therapy with intent-to-treat by transplantation for all patients with hepatocellular carcinoma was instituted at our transplant center in 1997. Data were prospectively collected to evaluate the impact of multimodality therapy on posttransplant patient survival, tumor recurrence, and patient survival without transplantation.
  
  
  METHODS
  All patients with hepatocellular carcinoma were eligible for multimodality therapy. Multimodality therapy consisted of hepatic resection, radiofrequency ablation, transarterial chemoembolization, transarterial chemoinfusion, yttrium-90 microsphere radioembolization, and sorafenib.
  
  
  RESULTS
  Approximately 715 patients underwent multimodality therapy; 231 patients were included in the intent-to-treat with transplantation arm, and 484 patients were treated with multimodality therapy or palliative therapy because of contraindications for transplantation. A 60.2% transplantation rate was achieved in the intent-to-treat with transplantation arm. Posttransplant survivals at 1 and 5 years were 97.1% and 72.5%, respectively. Tumor recurrence rates at 1, 3, and 5 years were 2.4%, 6.2%, and 11.6%, respectively. Patients with contraindications to transplant had increased 1- and 5-year survival from diagnosis with multimodality therapy compared with those not treated (73.1% and 46.5% versus 15.5% and 4.4%, P<0.0001).
  
  
  CONCLUSIONS
  Using multimodality therapy before liver transplantation for hepatocellular carcinoma achieved low recurrence rates and posttransplant survival equivalent to patients with primary liver disease without hepatocellular carcinoma. Multimodality therapy may help identify patients with less active tumor biology and result in improved disease-free survival and organ utilization.
authors: 1 Hume-Lee Transplant Center, Virginia Commonwealth University Medical Center, Richmond, VA. 2 Department of Radiology, Virginia Commonwealth University Medical Center, Richmond, VA. 3 Address correspondence to: Robert A Fisher, M.D., Virginia Commonwealth University Medical Center, 1200 East Broad Street, PO Box 980254, Richmond, VA 23298.
authors: Rajesh
authors: R
authors: Ramanathan
authors: Amit
authors: A
authors: Sharma
authors: David D
authors: DD
authors: Lee
authors: Martha
authors: M
authors: Behnke
authors: Karen
authors: K
authors: Bornstein
authors: R Todd
authors: RT
authors: Stravitz
authors: Malcolm
authors: M
authors: Sydnor
authors: Ann
authors: A
authors: Fulcher
authors: Adrian
authors: A
authors: Cotterell
authors: Marc P
authors: MP
authors: Posner
authors: Robert A
authors: RA
authors: Fisher
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D017115:Catheter Ablation / Q000009:adverse effects / Q000401:mortality; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009536:Niacinamide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000627:therapeutic use*; D011446:Prospective Studies; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D019275:Radiopharmaceuticals / Q000627:therapeutic use*; D018714:Radiotherapy, Adjuvant; D012307:Risk Factors; D000077157:Sorafenib; D013997:Time Factors; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
chemical_list: D010671:Phenylurea Compounds; D047428:Protein Kinase Inhibitors; D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes; D009536:Niacinamide; D000077157:Sorafenib