‘Reduce and remove’ strategy plus living donor transplant successfully cures terminal liver cancer in patient

A brand new therapy technique for regionally superior liver most cancers, often called “scale back and take away,” was introduced by the Division of Surgical procedure and Division of Scientific Oncology, Heart of Most cancers Drugs, College of Scientific Drugs, LKS College of Drugs of the College of Hong Kong (HKUMed) earlier this 12 months. This modern strategy offers a method for sufferers with inoperable regionally superior liver most cancers to be cured.

One exceptional case amongst sufferers handled with the “scale back and take away” technique concerned the conversion of stage 4 liver cancer to stage 1 most cancers, adopted by the elimination of the tumor by way of residing donor liver transplantation. This novel therapy was additionally used for a second affected person of superior age who subsequently underwent this liver-preserving surgical procedure.

The liver transplantation case was introduced on the Congress of the Asian Society of Transplantation 2023 and was lately revealed within the journal Liver Cancer.

Liver most cancers ranks because the fifth commonest most cancers in Hong Kong, with greater than 1,700 new instances per 12 months. Beforehand, liver surgical procedure and liver transplants have been the one healing therapies obtainable. Nonetheless, solely 30% of the sufferers are amenable to those treatment optionsleaving the remaining 70% of sufferers with a five-year general survival price of solely roughly 30%. Therefore, in depth analysis efforts are dedicated to increasing the position of surgical procedure or transplantation for this lethal illness, the place attainable.

Led by Professor Albert Chan Chi-yan, Scientific Professor, from the Division of Surgical procedure, College of Scientific Drugs, and Dr. Chiang Chi-leung, Scientific Assistant Professor, from the Division of Scientific Oncology, Heart of Most cancers Drugs, College of Scientific Drugs, HKUMed, the HKU liver most cancers analysis crew has pioneered the “scale back and take away” strategy, utilizing a mix technique of stereotactic physique radiation (SBRT) and immunotherapy (IO) to induce shrinkage of regionally superior liver most cancers.

For the primary time on the earth, Professor Chan and his crew efficiently cured stage 4 liver most cancers by “decreasing” it to an early stage 1 tumor with this mix technique after which “eradicating” it by residing donor liver transplantation. The analysis crew used the identical technique for an 85-year-old affected person with two liver cancers, probably the most senior affected person to this point, after which efficiently eliminated the tumor with liver-preserving surgical procedure.

The primary affected person, Mr. Wong (aged 65), who had hepatitis B, introduced with stomach distension in November 2022. Computed tomography confirmed a liver tumor 18.2cm in diameter, protecting the left aspect of his liver with essential portal vein invasion (stage 4). Mr. Wong’s tumor marker, AFP, was greater than 100,000ng/ml upon presentation, his life expectancy was about six months. Given Mr. Wong’s superior stage of illness, the liver most cancers analysis crew began the novel “scale back and take away” technique.

Over the next six months, Mr. Wong’s tumor measurement regularly decreased from the preliminary 18.2cm to 9cm on subsequent scans and his AFP degree dropped to 80ng/ml. To attain an entire treatment, liver transplantation was the one possible possibility, and his son volunteered to be the donor. The residing donor liver transplantation concerned two groups of surgeons. The operation was carried out on 21 August 2023 and took 12 hours. The operation was profitable, and Mr. Wong was discharged from hospital 15 days after his operation.

Submit-operative liver perform was regular, and his AFP degree remained at 2ng/ml within the three months after the transplantation. The ultimate evaluation of the liver revealed solely a 1.5cm tumor (stage 1) remaining viable; no different tumors have been present in the remainder of the liver. Mr. Wong has remained effectively and cancer-free for practically 4 months because the operation. That is believed to be the primary reported case on the earth.

The second affected person, Mr. Acquired (aged 85), with hypertension, diabetes and pulmonary tuberculosis, was discovered to have two liver cancers—one in the fitting aspect of the liver (6.5cm in diameter) and the opposite within the left aspect (3.1cm in diameter), which compressed left hepatic vein. Contemplating Mr. Acquired’s age, the surgical threat was very excessive.

After receiving the mixture “scale back and take away” therapy, the lively element of Mr. Acquired’s tumors shrank to 2.3cm and 1.8cm, respectively. Professor Chan and his surgical crew then efficiently carried out a parenchymal preserving liver surgical procedure to take away each tumors. Mr. Acquired recovered effectively and was discharged from hospital 4 days after the operation.

“The crew is honored to supply new hope and potentialities for the therapy of liver most cancers, curing the affected person by changing stage 4 liver most cancers to stage 1 most cancers, after which eradicating the tumor by residing donor liver transplantation, which is believed to be the primary such case on the earth. The restoration progress of the affected person is encouraging,” mentioned Professor Albert Chan Chi-yan, Scientific Professor, the Division of Surgical procedure, College of Scientific Drugs, HKUMed.

The crew’s modern “scale back and take away” therapy technique has profound analysis significance and scientific worth for liver most cancers sufferers and the medical neighborhood. “The HKU-pioneered ‘scale back and take away’ technique is a breakthrough in liver most cancers therapy,” Professor Chan additional defined.

“This technique successfully prolongs the lives of sufferers, particularly sufferers for whom the tumor stage and measurement should be diminished earlier than liver transplantation. Furthermore, this technique entails low invasiveness, and it’s secure and well-tolerated, even in aged sufferers, who’re usually not appropriate for high-risk and sophisticated surgical procedure.”

This therapy technique offers a particular therapy schedule. Most sufferers can have an thought of the therapy impact inside six months after the beginning of therapy, permitting higher planning for themselves and their households. The crew is trying ahead to seeing this new technique end in a brand new route of therapy for the world, inspiring extra analysis, innovation, communication and collaboration, and benefiting extra liver cancer sufferers.