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2007 Program and Abstracts | 2007 Posters
A Multidisciplinary Treatment Team for Patients with Hepatocellular Cancer At a Veterans Affairs Medical Center Improves Survival
Tammy T. Chang*1,2, Rajiv Sawhney3, Alexander Monto4, Jacob G. Kirkland2, Lygia Stewart1,2, Carlos U. Corvera1,2
1Department of Surgery, University of California, San Francisco, San Francisco, CA; 2Division of General Surgery, San Francisco Veterans Affairs Medical Center, San Francisco, CA; 3Division of Interventional Radiology, San Francisco Veterans Affairs Medical Center, San Francisco, CA; 4Division of Gastroenterology, San Francisco Veterans Affairs Medical Center, San Francisco, CA

Introduction. Several methods of treatment are available to treat hepatocellular carcinoma (HCC) and are often used in combination for either palliation or cure. We established a multidisciplinary treatment team (MDTT) at the San Francisco Veterans Affairs Medical Center (SFVAMC) and assessed whether aggressive multimodality treatment strategies may affect survival. Methods. A MDTT for hepatocellular carcinoma (HCC) was established in November 2003. A prospective database was established. Hospitalization and follow-up information from patients with presumed HCC was collected up to November 2006 (36 months). Information from the American College of Surgeons (ACS) cancer registry from January 2000 to Nov 2003 (47 months) identified patients with HCC that were evaluated at the same hospital. Treatment and outcomes data from the two time periods were compared. Results. From Jan. 2000 to Nov. 2006, 183 patients with HCC were referred for evaluation at SFVAMC. The ACS registry identified 62, whereas the MDTT prospective database identified 121 patients. Of the 62 patients from the ACS registry, 39 (63%) had untreatable disease and were offered supportive care and 23 (37%) patients were treated. Palliative treatments were carried out in 19 patients and consisted of radiofrequency ablation (RFA) in 8, systemic chemotherapy or radiation therapy in 7, transhepatic arterial embolization therapy (TAE) in 3, and percutaneous ethanol injection (PEI) in 1 patient. Four patients underwent curative treatments (2 transplantations and 2 resections). Overall survival for this group was 21% after a median follow-up of 4.5 months. Of the 121 patients from the MDTT database, 44 (36%) were offered supportive care while 77 (64%) were treated. Initial treatments were considered palliative in 54 patients and consisted of single or multiple sessions of TAE, PEI, or RFA. Curative treatments were pursued in 23 (19%) patients (6 transplantations and 17 resections). The overall survival in the MDTT group was 65% after a median follow-up of 9.5 months. Conclusion. Establishment of a MDTT resulted in doubling patient referrals, of whom more were offered either palliative or curative treatments. Overall survival and follow-up were significantly improved.

Jan 2000- Nov 2003 (n=62) Nov 2003-Nov 2006 (n=121)
Not Treated 39 (63%) 44 (36%)
Treated 23 (37%) 77 (64%)*
Palliative 19 (31%) 54 (45%)
Curative 4 (6%) 23 (19%)
Survival 13 (21%) 79 (65%)*

* p<0.0001 by Fisher's exact test

2007 Program and Abstracts | 2007 Posters
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