Surgeons and oncologists at the University of Utah are using liver transplants to treat a rare, deadly cancer. Cholangiocarcinoma — bile duct cancer — previously had no effective therapy and is usually lethal.

"Once it's diagnosed, the prognosis is very grim," said Dr. Jason Schwartz, assistant professor of transplant surgery and a surgeon at the U. and Huntsman Cancer Hospital.

Researchers elsewhere discovered some years ago that patients given high doses of chemotherapy and radiation lived longer, although it did not cure the cancer. But providing a high enough dose killed the liver.

The Mayo Clinic, where Schwartz received some of his training, conceived of delivering high-dose chemo and radiation in conjunction with a liver transplant. That has proven very effective, especially in terms of survival for people with early disease. At five years, 86 percent are alive. Without a transplant, average survival is about six months after diagnosis, he said.

Few centers offer the procedure, which requires special approval from their institutional review boards and from the United Net- work for Organ Sharing, which oversees distribution of organs for transplant. So far, the multidisciplinary team at the U. has treated three patients that way, with good results, said Schwartz.

"They have resumed working and gone back to living productive lives and spending time with their families," he said. "The disease appears to be in check."

It's of particular interest in Utah, where Schwartz described cholangiocarcinoma as being "surprisingly endemic" because of its link to white European populations and to certain diseases, including Crohn's and irritable bowel disease.

It's still early in the process of figuring where such transplants fit in the big picture of organ donation and transplant, he said. There are never enough organs to go around. Nationally, 16,191 individuals are on waiting lists for a liver transplant, 117 of them in Utah. Utah has three centers that perform liver transplants: the U., Intermountain Medical Center and Primary Children's Medical Center.

"It's difficult to say how many could benefit from this a year," Schwartz said. "It's a rare disease, but this certainly offers a ray of hope for people who previously didn't have any options."

Experts agree there's a need to standardize protocols so that results can be compared and for more research. Schwartz hopes more centers will collect and store tissue, which Huntsman does, so that biological characteristics of the cancer can be studied in detail to come up with more effective combinations of chemotherapy and radiation. It's also incredibly important, he said, to improve early detection through active screening.

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