Stereotactic Body Radiation Therapy: A New Strategy for Loco-Regional Treatment for Hepatocellular Carcinoma While Awaiting Liver Transplantation
Trans-arterial chemoembolization and radiofrequency ablation are commonly used for control of hepatocellular carcinoma (HCC) on liver transplant (LTx) waiting list. Stereotactic body radiation therapy (SBRT) was introduced to our institution for HCC as a bridging or downsizing therapy to LTx.
Patients and methods
Twenty-five HCC lesions in 22 patients were treated with SBRT while waiting for LTx from January 2010 to December 2015. Nineteen of these patients received deceased donor LTx. SBRT was defined as 40–50 Gy delivered in 4–6 fractions. Pre- and post-liver transplant outcome were analyzed in addition to the dropout rate and tumor response to SBRT.
Median size of original tumors was 3.2 cm (2.0–8.9), and median size of tumor after SBRT was significantly smaller at 0.9 cm (0–3.2) in the explanted livers (p < 0.01). The dropout rate was 9%, and they were only downsized patients outside of Milan criteria. Liver disease did not progress between pre- and post-SBRT except one patient. Twenty-eight percent of treated HCCs showed complete pathologic response, and 22% had extensive partial response with some residual tumor. No HCC recurrence was experienced after LTx.
SBRT is indicated to be safe, effective treatment for HCC on LTx waiting list, and it leads to satisfactory post-liver transplant outcomes.
Stereotactic body radiation therapy
Radiation induced liver disease
Model for end-stage liver disease
Planned target volume
Compliance with ethical standards
Conflict of interest
The authors who have taken part in this study declared that they do not have anything to disclose regarding conflict of interest with respect to this manuscript.
- 3.Abdelmaksoud AH, Mandooh S, Nabeel MM, Elbaz TM, Shousha HI, Monier A et al (2017) Portal vein thrombosis in unresectable Hcc cases: a single center study of prognostic factors and management in 140 patients. Asian Pac J Cancer Prev 18(1):183–188Google Scholar
- 16.Cancer Therapy Evaluation Program, Common Terminology Criteria for Adverse Events, Version 4.0, (http://ctep.cancer.gov), Publish Date: May 28, 2009
- 20.Kennedy A, Nag S, Salem R, Murthy R, McEwan AJ, Nutting C et al (2007) Recommendations for radioembolization of hepatic malignancies using yttrium-90 microsphere brachytherapy: a consensus panel report from the radioembolization brachytherapy oncology consortium. Int J Radiat Oncol Biol Phys 68:13–23CrossRefGoogle Scholar
- 22.Leibel SA, Pajak TF, Massullo V, Order SE, Komaki RU, Chang CH (1987) A comparison of misonidazole sensitized radiation therapy to radiation therapy alone for the palliation of hepatic metastases: results of a Radiation Therapy Oncology Group randomized prospective trial. Int J Radiat Oncol Biol Phys 13:1057–1064CrossRefGoogle Scholar