Sobol, Anna L.

14034 Background: While orthostatic liver transplant (OLT) is an accepted treatment for localized hepatocellular carcinoma (HCC), little data exists as to the appropriate treatment of recurrent disease. Consensus opinion favors avoiding systemic chemotherapy on the grounds that toxicity would be poorly tolerated by patients medically immunosuppressed to prevent allograft rejection. Methods: Study design: retrospective chart review. The medical records of all patients who underwent OLT at the Mayo Clinic in Jacksonville, Florida, from February 1998 to April 2005 were reviewed. Those patients who developed recurrent HCC treated with systemic chemotherapy and were followed for at least 5 weeks with documented side effects were identified as the study population. Tolerance of treatment was assessed through review of side effects and Eastern Co-operative Oncology Group (ECOG) performance status scores. Disease progression was identified as increasing size of lesions on computed tomography (CT) scans and increasing serum alpha fetoprotein (AFP) levels. The primary endpoint was defined as discontinuation of chemotherapy due to severe side effects. Results: Of 1133 patients undergoing OLT, 179 were diagnosed with HCC. Thirty developed recurrent disease. Of these, 8 did not receive chemotherapy (2 observation only, 2 Hospice care, 2 radiation therapy, 1 surgical resection, 1 chemoembolization), 10 were lost to follow-up, and 2 died of rapidly progressive disease. The remaining 10 patients underwent systemic chemotherapy with six patients receiving multiple regimens. Seven patients received from 2 to 15 cycles of gemcitabine and cisplatin. Cytopenias were the most common side effect. One patient discontinued the regimen after developing neutropenic fever following 2 cycles of treatment. Five patients received from 1 to 12 cycles of capecitabine. Diarrhea was the most common side effect. Three patients received from 3 to 6 cycles of doxorubicin. Stomatitis and cytopenias were the most common side effects. No treatment related mortalities were observed. Conclusions: Palliative systemic chemotherapy is not usually associated with life threatening side effects and therefore is a viable option for patients with recurrent HCC following OLT. No significant financial relationships to disclose.