Finding Better Options -- Liver Transplant Life Expectancy Increased Through Neoadjuvant Chemoradiation
Investigators: David Rea, M.D.; Julie Heimbach, M.D.; Charles Rosen, M.D.; Michael Haddock, M.D.; Steven Alberts, M.D.; Walter Kremers, Ph.D.; Gregory Gores, M.D.; and David Nagorney, M.D.

Mayo Clinic Cancer Center researchers study a variety of cancers, ranging from the most common to the rarest. They seek to lessen the burden on society -- not just for Americans, but for those who suffer from cancer worldwide. Bile duct cancer affects only a small number (4,600) people in the United States each year, reports the American Cancer Society, although the incidence is increasing. However, it disproportionately appears in Asia and the Middle East due to a common parasitic infection of the bile duct. It also is more commonly found in men than in women.

Conventional therapy for people diagnosed with hilar cholangiocarcinoma, cancer in a specific area of the bile duct system, is to surgically remove the tumor. This surgery often includes removing a large part of the liver. However, for patients with extensive hilar cholangiocarcinoma that invades too much of the liver to leave enough for survival, liver transplant has long been thought to be the only option that has a chance to succeed.

In the late 1980s and early 1990s, number of researchers around the world reported poor 5-year survival rates (20 to 30 percent) and over 50 percent recurrence using liver transplantation and surgical removal of the cancer. This caused some reluctance to move forward with liver transplants, but as it still provided hope for a small group, Mayo Clinic continued to offer the option.

Some Mayo patients who did not receive surgery were treated with primary radiotherapy and chemosensitization, resulting in 22 percent reaching 5-year survival rates. Because of the promising results seen in this area, it was logical to attempt to combine the two marginally-successful strategies to see if increases in survival rate could be achieved for a larger percentage of patients. Transplant specialists, radiation oncologists, medical oncologists and gastroenterologists worked together to design a treatment protocol that combined radiotherapy, chemosensitization and liver transplantation for appropriate patients.

In 2004, Mayo Clinic researchers were able to report possibly the largest ever increase in survival rate through a change in practice, showing 82 percent reaching 5-year survival, of the initial 28 patients to receive the protocol from 1993 through 2004. Their findings were published in the September 2005 issue of Annals of Surgery.