Asia-Pacific Journal of Clinical Oncology (Asia Pac J Clin Oncol)

Publications in this journal

• Article: Future Saudi doctors and cancer patients agree cancer patients should be informed about their cancer.

  Ali M Al-Amri
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  ABSTRACT: AIM: To compare attitudes of Saudi medical students and Saudi cancer patients towards disclosure of cancer information and to examine whether differences exist between students and patients, level of education or gender and region of residence. METHODS: Data were collected from 384 students and 368 patients using a nine-question questionnaire on attitudes to cancer. RESULTS: Almost all patients (98%) wanted to receive all the information should they get cancer compared with 93% of students (P = 0.001) and almost no patients and students wanted the information hidden (99 vs 98%, P = 0.273). If they became ill students were more likely to share information with their family and friends than patients. Fewer than 2% of patients did not want to know the benefits of chemotherapy compared to 3% of students, while 99% of patients wanted to know the side-effects compared to 93% of students (P = 0.095 and P = 0.001, respectively). Almost all patients and students (99 vs 98%) would refuse treatment without knowing their diagnosis (P = 0.401). Patients wanted to know the prognosis more than students (98 vs 92%; P = 0.001). In all, 99% of male students wanted their cancer diagnosis disclosed compared with women (98%; P = 0.615). Gender, education level, regions and age did not affect the desire of cancer patients to know their prognosis (P = 0.275, P = 0.664, P = 0.0314 and P = 0.164, respectively). CONCLUSION: There was a consensus among cancer patients and medical students that cancer information, including diagnosis, treatment effects and prognosis, should be disclosed to patients.
  Asia-Pacific Journal of Clinical Oncology 05/2013;
• Article: Localized versus centralized nurse-delivered telephone services for people in follow up for cancer: Opinions of cancer clinicians.

  James D Harrison, Ivana Durcinoska, Phyllis N Butow, Kathryn White, Michael J Solomon, Jane M Young
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  ABSTRACT: AIM: Telephone-delivered supportive care interventions hold potential as a sustainable, low-resource option to improve patients' outcomes. Such interventions may be delivered centrally or locally. There is limited information about clinicians' preferences for these alternative models of service delivery. This study investigated the views of cancer clinicians who had experience of a centralized model. METHODS: Interviews were conducted with 16 surgeons and nurses across New South Wales, Australia, who had participated in a trial of a centralized telephone-based supportive care intervention. Content analysis was conducted. Data were analyzed inductively and responses organized into categories and then higher order themes. RESULTS: All clinicians valued the role of telephone follow ups as they would allow patients to ask questions and receive reassurance. Clinicians believed these services could reduce hospital presentations and provide equity and standardized care, particularly to those outside metropolitan centers. Although clinicians accepted a centralized model of delivery would be cheaper, most (n = 15) indicated a preference for local delivery. This preference was based on the perception that local nurses would have superior knowledge of the local context. Despite the improved feasibility of a telephone-only service, clinicians felt some face-to-face contact with patients was essential. Key at-risk groups to target were identified. Clinicians acknowledged there could be overlap with cancer nurses locally requiring local decisions about implementation. CONCLUSION: There was clear endorsement of additional telephone support with a preference for a local model of service delivery. The limited acceptability of centralized telephone-based supportive care interventions may restrict their uptake.
  Asia-Pacific Journal of Clinical Oncology 05/2013;
• Article: Minimal important differences in the EORTC QLQ-C30 in patients with advanced cancer.

  Gillian Bedard, Liang Zeng, Liying Zhang, Natalie Lauzon, Lori Holden, May Tsao, Cyril Danjoux, Elizabeth Barnes, Arjun Sahgal, Michael Poon, Edward Chow
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  ABSTRACT: AIMS: Quality of life (QOL) is important in patients with advanced cancer. The European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 is a general QOL tool used in cancer patients. Often, with a large enough sample, statistical significance of changecan be reached, however the clinical significance is often unknown. This study aimed to determine the magnitude of change that is meaningful to advanced cancer patients in the EORTC QLQ-C30. METHODS: Patients completed the EORTC QLQ-C30 at baseline and 1 month post-radiation to assess changes in their QOL. Minimal important differences (MID) were calculated through anchor and distribution-based methods for improvement and deterioration. The two anchors of overall health and overall QOL were used to determine meaningful change. RESULTS: Statistically significant meaningful changes were seen in the use of both anchors. The overall health anchor produced a greater number of scales and symptoms that reached a statistically significant meaningful change. Meaningful change for improvement with these two anchors ranged from 9.1 units (cognitive functioning) to 23.5 units (pain), and for deterioration it ranged from 7.2 units (physical functioning) to 13.5 units (role functioning). Distribution-based estimates were closest to 0.5 SD. CONCLUSION: Knowledge of meaningful change on the EORTC QLQ-C30 allows physicians to assess patients' changes over time, along with evaluating the impact of treatment on a patient's QOL. This knowledge gives insight into whether the treatment is effective and, ultimately, whether it should be continued. Knowledge of MID may assist in the determination of sample size for future trials.
  Asia-Pacific Journal of Clinical Oncology 04/2013;
• Article: Minimal important differences in the EORTC QLQ-C15-PAL to determine meaningful change in palliative advanced cancer patients.

  Gillian Bedard, Liang Zeng, Liying Zhang, Natalie Lauzon, Lori Holden, May Tsao, Cyril Danjoux, Elizabeth Barnes, Arjun Sahgal, Michael Poon, Katharine Hicks, Edward Chow
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  ABSTRACT: AIMS: Quality of life (QOL) is important for advanced cancer patients. Brief questionnaires are advantageous to reduce patient burden. In large clinical trials, statistically significant small changes can be achieved; however, whether such change is clinically relevant is unknown. The purpose of this study was to determine the minimal important differences (MID) of the European Organisation for Research and Treatment of Cancer quality of life core 15 palliative questionnaire (EORTC QLQ-C15-PAL). METHODS: Patients undergoing palliative radiotherapy completed the EORTC QLQ-C15-PAL at baseline and 1 month later. Anchor and distribution-based assessments were employed to determine the MID associated with this instrument. The anchor of overall QOL was used to determine meaningful change. RESULTS: In all, 276 patients were included in MID calculation. Mean age was 65 years and primary lung, breast or prostate cancers were most common. Statistically significant MID for improvement was seen in emotional functioning and pain (20.9 and 15.6, respectively). MID for deterioration required a 20.4, 24.5, 17.1 and 23.0 change in physical functioning, fatigue, pain and appetite loss, respectively, to constitute meaningful change. Distribution-based estimates of MID were closest to the standard error of measurement. MID for brain and bone metastases patients yielded MID larger than previously determined in the incorporation of all patients. CONCLUSION: Meaningful change in the EORTC QLQ-C15-PAL is important for clinicians to determine the impact of treatment on the QOL of patients and can aid in determining the sample size required for clinical trials. Future studies should investigate MID in subgroups using symptom-specific modules.
  Asia-Pacific Journal of Clinical Oncology 04/2013;
• Article: Comparison of the EORTC QLQ-BM22 and the BOMET-QOL quality of life questionnaires in patients with bone metastases.

  Gillian Bedard, Liang Zeng, Michael Poon, Henry Lam, Natalie Lauzon, Edward Chow
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  ABSTRACT: AIMS: Bone metastases are a common complication of advanced cancer and often result in a decrease in patients' quality of life. Very few specific modules have been created to accurately assess quality of life in this patient group. The purpose of this study was to compare two questionnaires, the European Organization for Research and Treatment of Cancer quality of life questionnaire for patients with bone metastases (EORTC QLQ-BM22) and the bone metastases quality of life questionnaire (BOMET-QOL. METHODS: A literature search was conducted in Medline, Health and Psychosocial Instruments, Embase and Embase Classic to identify studies that discussed the development, validation and reliability of the (EORTC) QLQ-BM22 and the BOMET-QOL. Studies that discussed the development and validity of the questionnaire along with studies using these tools were included. RESULTS: Both questionnaires were developed in collaboration with patients and health-care professionals. The QLQ-BM22 is over twice the length of the BOMET-QOL, with 22 questions as compared to 10. The QLQ-BM22 has four subscales while the BOMET-QOL has no subscales. The QLQ-BM22 gives a more in-depth analysis of symptoms and well-being and includes issues such as mobility, side effects, complications of treatment and dependency. The BOMET-QOL is shorter and gives an overall assessment of pain and mobility. Scoring, item format, organization and response options vary between the questionnaires but the recall period for both is the previous week. Both questionnaires have been determined valid and reliable. CONCLUSION: The QLQ-BM22 and the BOMET-QOL are designed specifically for patients with bone metastases and each has strengths and weaknesses. Use of one over the other is ultimately dependent on trial design and investigators' goals.
  Asia-Pacific Journal of Clinical Oncology 04/2013;
• Article: Evaluation of diagnostic value of four tumor markers in bronchoalveolar lavage fluid of peripheral lung cancer.

  Jian Li, Ping Chen, Chao-Ming Mao, Xing-Ping Tang, Li-Rong Zhu
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  ABSTRACT: AIM: The diagnostic role of carcinoembryonic antigen (CEA), squamous cell carcinoma (SCC) antigen, Cyfra 21-1 and neuron-specific enolase (NSE) in the bronchoalveolar lavage fluid (BALF) for lung cancer is still controversial. The aim of this study was to evaluate the diagnostic value of these four tumor markers in BALF for peripheral lung cancer. METHODS: We measured and compared the levels of CEA, SCC, Cyfra21-1 and NSE in BALF in 42 patients with peripheral lung cancer and 22 patients with benign lung disease. In the patients with peripheral lung cancer, the BAL was separately performed in the bronchus of the tumor-bearing lung and in the corresponding bronchus of the opposite healthy lung. RESULTS: The levels of CEA, SCC, Cyfra21-1 and NSE were significantly elevated in BALF from the tumor-bearing lung compared with the opposite healthy lung in the lung cancer patients (P < 0.001) or the benign lung disease patients (P < 0.005). The diagnostic sensitivities of Cyfra21-1 (86 and 76%), with a specificity of 91%, were the highest among the four tumor markers for the tumor-bearing lung versus the opposite healthy lung and benign lung disease. The combination of Cyfra21-1 and CEA increased the sensitivity to 93 and 86 percent, respectively. CONCLUSION: The assay of these tumor markers in BALF may be used as a diagnostic tool to complement a cytological examination in the diagnosis of peripheral lung cancer.
  Asia-Pacific Journal of Clinical Oncology 04/2013;
• Article: Clinical significance of vascular endothelial growth factor and vascular endothelial growth factor receptor-2 gene polymorphisms in patients with gastrointestinal stromal tumors.

  Byung Woog Kang, Jong Gwang Kim, Yee Soo Chae, Han Ik Bae, Ohkyoung Kwon, Ho Young Chung, Wansik Yu, Hong Suk Song, Yu Na Kang, Seung Wan Ryu, Kyung Hee Lee, Young Kyung Bae, Joon Hyuk Choi, Se Won Kim, Hun-Mo Ryoo, Chang-Ho Cho, Hyun-Dong Chae, Kyun Woo Park, Mi Jin Gu, Byung-Jo Bae
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  ABSTRACT: AIM: The vascular endothelial growth factor (VEGF) or its family might play role in tumor-related angiogenesis in gastrointestinal stromal tumors (GIST), thereby affecting the prognosis. Accordingly, the present study analyzed the impact of VEGF and VEGF receptor-2 (VEGFR-2) gene polymorphisms on the prognosis for GIST patients. METHODS: In all, 213 consecutive patients with GIST from five medical centers were enrolled in the present study. The genomic DNA was extracted from paraffin-embedded tumor tissue, and four VEGF (-2578C/A, -1498C/T, -634G/C, and +936C/T) and one VEGFR-2 (+1416A/T) gene polymorphisms were determined using a Sequenom MassARRAY system. RESULTS: With a median follow up of 18.4 months, the estimated 5-year relapse-free survival and overall survival rates were 70 and 87%, respectively. In a multivariate analysis including age, sex, primary site of disease, pathology and risk stratification, no significant association was observed between the polymorphism of the VEGF and VEGFR-2 genes and survival. CONCLUSION: None of the five VEGF and VEGFR-2 gene polymorphisms investigated in this study was found to be an independent prognostic marker for Korean patients with surgically resected GIST. However, further studies on a larger scale are warranted to clarify the role of VEGF and VEGFR gene polymorphisms as a prognostic biomarker for GIST patients.
  Asia-Pacific Journal of Clinical Oncology 04/2013;
• Article: Fruit and vegetable intake and prostate cancer risk: A meta-analysis.

  Hongzhou Meng, Wenyi Hu, Zhaodian Chen, Yuehong Shen
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  ABSTRACT: AIMS: Recent reports have examined the effect of fruit and vegetable intake on the risk of prostate cancer, but the results are inconsistent. A meta-analysis of prospective studies was conducted to arrive at quantitative conclusions about the contribution of vegetable and fruit intake to the incidence of prostate cancer. METHODS: A comprehensive, systematic search of medical literature published up to June 2012 was performed to identify relevant studies. Separate meta-analyses were conducted for fruit and vegetable consumption. The presence of publication bias was assessed using Egger and Begg tests. RESULTS: In total, 16 cohort studies met the inclusion criteria and were included in the meta-analysis. The combined adjusted relative risk comparing highest with lowest categories showed that there was no association between vegetable and fruit consumption and prostate cancer incidence. The pooled relative risk was 0.97 (95%CI 0.93, 1.01) for vegetables and 1.02 (95%CI 0.98, 1.07) for fruit. There is no heterogeneity between the studies. No publication bias was detected. CONCLUSION: This meta-analysis suggests that total fruit or vegetable consumption may not exert a protective role in the risk of prostate cancer.
  Asia-Pacific Journal of Clinical Oncology 04/2013;
• Article: Communicating with brain tumor patients about driving: Are we falling short of the mark?

  Kathryn M Field, Ngaere Guyatt, Marcia Fleet, Mark A Rosenthal, Kate Drummond
  Asia-Pacific Journal of Clinical Oncology 04/2013;
• Article: Breast cancer survival of Hispanic women in the USA is influenced by country of origin.

  Subhankar Chakraborty, Lynette Smith, Apar Kishor Ganti, Neelima Bonthu, Tomohiro Shimizhu, Surinder K Batra
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  ABSTRACT: AIM: People of Hispanic origin comprise nearly 16 percent of the (US) population. With the growing population of Hispanics in the USA, an important epidemiological question is whether their country of origin affects survival in Hispanic women living in the USA at the time of diagnosis of breast cancer. METHODS: We searched the Surveillance Epidemiology and End Results (SEER) database for Hispanic women with a single primary breast cancer with known country of origin diagnosed between 1973 and 2008. Univariate and multivariate analyses were performed to evaluate whether the country of origin was an independent predictor of survival. RESULTS: In total, 48 849 female breast cancer patients of Hispanic origin were included in the SEER database. Nearly 23 percent of them had an origin in Mexico, 9 percent in South or Central America 3 percent in Puerto Rico, 2 percent in Cuba, 0.3 percent in the Dominical Republic and 3 percent in other countries, including Europe. About 60 percent of patients were identified as Hispanic by their surname or classified as Spanish/Hispanic not otherwise specified. Median survival of patients in these groups was 204, 240, 142, 169, 82.4, 115.5 and 210 months, respectively (P < 0.0001 by log-rank test). Univariate and multivariate analysis showed that the country of origin was an independent predictor of survival in Hispanic women with breast cancer. CONCLUSION: The country of origin is an independent predictor of overall survival among Hispanic women diagnosed with breast cancer.
  Asia-Pacific Journal of Clinical Oncology 04/2013;
• Article: Selecting the right patients for testing novel agents in hepatocellular carcinoma: who, when and how?

  Stephen L Chan, Winnie Yeo
  Asia-Pacific Journal of Clinical Oncology 03/2013; 9(1):2-5.
• Article: 2012: Year in Review - from dragons to snakes.

  Stephen Ackland, Yuko Fukuda
  Asia-Pacific Journal of Clinical Oncology 03/2013; 9(1):1.
• Article: Metastasis and anesthesia: A new relationship.

  Meng Ji
  Asia-Pacific Journal of Clinical Oncology 02/2013;
• Article: Detection of serum protein biomarkers by surface enhanced laser desorption/ionization in patients with adenocarcinoma of the lung.

  Min Jiang, Guohao Gu, Bin Ni, Wenjing Wang, Jinfang Shi, Ping Liao, Heng Hu
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  ABSTRACT: AIM: Early diagnosis of lung cancer is important for successful treatment and improving the outcome of patients. We explored novel tools for screening serum biomarkers to distinguish adenocarcinoma of the lung from healthy controls by serum protein profiles. METHODS: Serum samples were taken from 31 patients with adenocarcinoma of the lung and 31 healthy controls, matched for age, sex and smoking status. Serum samples were applied to strong anion 2(SAX-2) protein chips to generate mass spectra by surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF-MS). Protein peak identification and clustering were performed using Biomarker Wizard, compared by MATLAB 7.5 and a classification tree was constructed using R weka software. The validity of the classification tree was then challenged with a blind test. RESULTS: The software identified 102 peaks and m/z 14022.9 and m/z 3735.99 was used to construct a classification tree. The classification tree effectively separated adenocarcinoma of lung patients from healthy controls, achieving a validity of 100%. The blind test challenged the model with a sensitivity of 100% and a specificity of 100%. CONCLUSION: The results suggested that the SELDI-TOF-MS technique can correctly distinguish adenocarcinoma of lung patients from healthy controls and showed great potential for development as a screening test for the detection of lung cancer.
  Asia-Pacific Journal of Clinical Oncology 02/2013;
• Article: Pemetrexed in combination with cisplatin versus cisplatin monotherapy in East Asian patients with recurrent or metastatic head and neck cancer: Results of an exploratory subgroup analysis of a phase III trial.

  Susan Urba, Ruey-Long Hong, Anwar M Hossain, Rebecca Cheng, Mauro Orlando
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  ABSTRACT: AIM: An exploratory subgroup analysis of East Asian (EA) patients in a phase III trial was conducted to assess efficacy and safety trends based on ethnicity. METHODS: The 795 patients with recurrent or metastatic squamous cell carcinoma of the head and neck included 111 EA patients randomized to pemetrexed-cisplatin (n = 55) and placebo-cisplatin (n = 56) and 684 non- EA patients randomized to pemetrexed-cisplatin (n = 343) and placebo-cisplatin (n = 341). Treatment differences in median overall survival and progression-free survival were compared using a stratified log-rank test. Survival was estimated using the Kaplan-Meier method. RESULTS: The median overall survival in the pemetrexed-cisplatin and placebo-cisplatin arms of the EA group (6.8 and 5.7 months, respectively [P = 0.275]) was similar to that in the global population (7.3 and 6.3 months, respectively [P = 0.082]); the median progression-free survival in the pemetrexed-cisplatin and placebo-cisplatin arms in the EA group (2.8 and 1.9 months, respectively [P = 0.748]) was similar to that in the global population (3.6 and 2.8 months, respectively [P = 0.166]). Compared to the findings in the global population, overall survival for the EA group receiving prior platinum-based therapy was longer (P = 0.042 vs P = 0.065). There was no significant interaction between treatment arms and ethnicity. CONCLUSION: Consistent with findings in the global population, pemetrexed-cisplatin did not improve survival compared with placebo-cisplatin for the EA group. However, in a subgroup analysis, pemetrexed-cisplatin showed an overall survival advantage in EA patients receiving prior platinum-based therapy.
  Asia-Pacific Journal of Clinical Oncology 02/2013;
• Article: Is extramedullary relapse of acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation associated with improved survival?

  Cameron Curley, Simon Durrant, Glen A Kennedy
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  ABSTRACT: AIMS: Recent reports have suggested that extramedullary (EM) relapse of acute myeloid leukemia (AML) post-hematopoietic stem cell transplantation (HSCT), unlike isolated bone marrow (BM) relapse, is associated with improved prognosis. We reviewed the outcomes of relapsed AML post-HSCT at our institution to determine whether survival for patients with EM relapse was truly improved in comparison to patients suffering BM relapses treated in a similar (active) way. METHODS: Outcomes of all 274 allogeneic HSCT performed for adult AML between 2000 and 2010 at our institution were retrospectively reviewed. RESULTS: As of January 2011, 72 relapses post-HSCT had occurred, including 64 BM relapses (89%), two concomitant BM and EM relapses (3%), and six EM relapses alone (8%). EM relapses occurred significantly later post-HSCT than BM relapses (median 25.2 vs 3.9 months, respectively; P = 0.001). Patients suffering an EM relapse were significantly more likely to receive active therapy at relapse (7/8; 88%) than those suffering a BM relapse alone (28/64; 44%; P = 0.026). When survival analysis was restricted to outcomes of patients treated actively (i.e., with curative intent), no difference in outcome between EM and BM relapses was observed (median survival 13.5 vs 8 months for EM vs BM relapses, respectively, P = 0.44). CONCLUSIONS: Our results suggest that EM relapse post-HSCT has similar outcomes to BM relapses treated in a similar way. Furthermore, choice of therapy at relapse appears related to the time post-HSCT that the relapse occurs, with BM relapses occurring significantly earlier post-HSCT than relapses at EM sites.
  Asia-Pacific Journal of Clinical Oncology 02/2013;
• Article: Malignant hepatic epithelioid hemangioendothelioma with high-output heart failure: Successful management of heart failure with transcatheter arterial chemoembolization.

  Chien-Yi Hsu, Yao-Chung Liu, Chung-Pin Li, Po-Hsun Huang, Chin-Hsuan Lin, Yee Chao
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  ABSTRACT: A 73-year-old woman was admitted to hospital because of progressive dyspnea on exertion. Computed tomography revealed a large hepatic tumor, which was proved to be a hepatic epithelioid hemangioendothelioma (EHE). Echocardiography demonstrated high cardiac output, for which the tumor was considered to be the leading cause. A transcatheter arterial chemoembolization (TACE) was performed sequentially at 1-month intervals to reduce the size of the hepatic tumor, and this temporarily improved the patient's cardiac condition and quality of life. In this case, we successfully used TACE in the treatment of hepatic EHE with high-output heart failure. TACE is a reasonable choice of treatment both for managing malignant hepatic tumors and resolving low systemic vascular resistance by embolization of the abnormal neoangiogenic vessels. Nevertheless, clinicians should be aware of the potential adverse effect of hepatic decompensation induced by TACE, especially when the tumor involvement is widespread and poorly preserved hepatic function is encountered.
  Asia-Pacific Journal of Clinical Oncology 02/2013;
• Article: Potential benefits and pitfalls of respiratory-gated radiotherapy in the treatment of thoracic malignancy.

  Eric Hau, Melissa Rains, Trang Pham, Rebecca Muirhead, Roland Yeghiaian Alvandi
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  ABSTRACT: AIM: Despite advances in radiotherapy delivery, the prognosis of lung cancer remains poor. Higher doses of radiation have been associated with improved outcomes but may result in higher toxicities. Respiratory gated radiotherapy (RGRT) has the potential to reduce pulmonary toxicity but there are significant limitations and pitfalls to its use. The aim of this article is to (i) describe the RGRT technique currently employed at Nepean and Westmead Hospitals; (ii) discuss the practical issues of implementing such a program; (iii) present the results of our RGRT program and (iv) review the potential uncertainties in using this technique and the methods we have used to overcome these. METHODS: A retrospective review of all patients who had a 4D-computed tomography (4D-CT) scan was undertaken. Records from treatment planning systems were used to assess the prospective gating program. RESULTS: Between September 2007 and June 2011, 53 patients at Nepean and 26 patients at Westmead Hospital underwent a 4D-CT. Between April and August 2011, 26 patients at Westmead Hospital underwent a prospective 4D-CT scan as treatment verification. Two of the 26 patients (7.7%) were found to have incomplete coverage of the planning target volume. Both patients underwent respiratory re-coaching, alleviating the need for replanning. CONCLUSION: RGRT may reduce doses to organs at risk with the potential for dose escalation. However its implementation requires significant staff training, treatment time and resources. Treatment verification with image guided radiation therapy are essential for safe delivery.
  Asia-Pacific Journal of Clinical Oncology 01/2013;
• Article: Use of proton pump inhibitors correlates with increased risk of colorectal cancer in Taiwan.

  Shih-Wei Lai, Kuan-Fu Liao, Hsueh-Chou Lai, Cheng-Li Lin, Fung-Chang Sung
  Asia-Pacific Journal of Clinical Oncology 01/2013;
• Article: Cancer in liver transplant recipients: Management and outcomes.

  Hilary L Martin, John Wc Chen, Bogda Koczwara
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  ABSTRACT: AIM: To investigate the management and cancer outcomes of liver transplant recipients. METHOD: An audit of all liver transplant recipients from a single liver transplant center from January 1991 to March 2010. Data were obtained from case notes, cancer registry and clinical databases. RESULTS: 198 transplant recipients were identified and 49 (25%) were confirmed as having post-transplantation malignancies. Of these 32 (16%) patients developed skin malignancies and 17 (9%) developed post-transplant non-skin malignancies. All skin malignancies had local involvement only and none of the patients with skin malignancies developed nodal or distant metastases. All were managed with local treatment. Of those with non-cutaneous malignancies, four were managed with local therapy alone, two with immunosuppression reduction, seven with chemotherapy, including two with chemoradiotherapy, one with a targeted agent and three with supportive care only. None of the patients who were treated with chemotherapy for non-skin malignancies were able to complete the full prescribed dose of chemotherapy as a result of chemotherapy-related toxicities. Of those treated with chemotherapy one died of hepatic failure and one of chemotherapy-related infection. CONCLUSION: Liver transplant recipients are at high risk of cancer. Outcomes for liver transplant recipients with post-transplant malignancy are excellent if detected when they are amenable to local therapy alone. Outcomes are poor, with high rates of treatment-associated toxicity, in patients who require systemic therapy. Further research is required to enable the development of guidelines for the safe administration of systemic treatment in this group.
  Asia-Pacific Journal of Clinical Oncology 01/2013;