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Tuesday, February 19, 2013

Liver Transplants Increase Survival Rate for Non-Resectable Colorectal Liver Metastases

Cancer of the colon (also known as colorectal cancer) is uncontrolled abnormal cell growth in the colon or rectum (parts of the large intestine). Because the liver is situated above the large intestine, it is not uncommon for cancer to spread (metastasize) from the latter to the former. When this happens, it is known as a colorectal liver metastasis or CLM.

Many patients with CLMs have non-resectable disease, meaning that the cancer cannot be surgically removed without replacing the entire organ. However, because these cancers tends to re-occur, because the long-term survival rates are poor (few survive more than 5 years), and because so few donor livers are available in most countries, as of 1995 a decision was made in the medical community that liver transplants were no longer to be performed for patients with CLMs. The only option this leaves such patients is chemotherapy which has a very poor prognosis (5 year survival rate of less than 10%).

Researchers in Oslo, Norway, are challenging this way of thinking, especially since liver transplants offer the chance for a cure and because survival after liver transplants has improved by as much as 30% over the past two decades. The researchers decided to perform an initial study and use liver transplants as a treatment for 21 patients with non-resectable CLMs. The study was done relatively easily in Norway because in that country there is actually a liver donor surplus, where the wait for a liver donor is less than a month (in the U.S. it can take years to find a liver donor and many people die before one is available).

In the study, 21 patients with CLMs received liver transplants. None of the patients had detectable cancer that spread to other parts of their body, the main (primary) tumor in the colorectal area had been removed already, and the patients received at least  six weeks of chemotherapy. The study results were a great success, showing that 95% of patients had survived after one year, 68% survived after 3 years, and 60% survived after 5 years.  Compare this to prior to 1995 when only 62% of patients survived liver transplants after CLMs one year later and only 18% survived 3 years later. Additional good news reported in the study was that for patients who had a cancer recurrence after liver transplant, a significant proportion of these were accessible for surgical removal and after a median follow-up of 27 months, 33% had no evidence of disease. The results of the Norway study are soon to be published in the Annals of Surgery.

Suggested reading:  American Cancer Society's Complete Guide to Colorectal Cancer

Related blog entry: Colonoscopy Prep Made Easy: A New Cleanser

Reference:  Hagness M, Foss A, Line PD, Scholz T, Jørgensen PF, Fosby B, Boberg KM, Mathisen O, Gladhaug IP, Egge TS, Solberg S, Hausken J, Dueland S. (2013, in press). Liver Transplantation for Nonresectable Liver Metastases From Colorectal Cancer. Ann Surg.

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