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Stereotactic ablative radiation therapy prior to liver transplantation in hepatocellular carcinoma

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Abstract

Objective

Stereotactic ablative radiotherapy (SABR) is a safe treatment approach for hepatocellular carcinoma (HCC) with comparable effectiveness to other local therapies. Only scant information is available concerning the role of SABR prior to liver transplantation (LT) for HCC. We present a consecutive case series investigating the role of SABR as a bridge or downstaging option in HCC patients subsequently submitted to LT.

Materials and methods

Between September 2012 and May 2014, 8 patients for a total of 13 lesions underwent SABR prior to LT. Inclusion criteria were a pathological or radiological diagnosis of HCC, lesion size ≤6 cm or lesion number ≤3 with a total diameter ≤6 cm, no extrahepatic metastases, Child-Pugh class A–B, ECOG performance status ≤1. Patients were prescribed 36–48 Gy in 3–5 fractions (8 Gy × 5 fractions or 16 Gy × 3 fractions), in 3–5 consecutive days according to clinical and dosimetric decision making. Radiological response was evaluated according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST). Pathological response was assessed through the rate of tumor necrosis relative to the total tumor volume. Acute and late toxicities were scored using the National Cancer Institute Common Terminology Criteria for Adverse Events version 4 (CTCAE v 4.0).

Results

Among the 13 pathologically evaluated lesions, 8 (61.5 %) lesions had a complete response 2 (15.3 %) had a minimal pathological response and other 2 (15.3 %) showed stable disease. The remaining lesion had a significant pathological response. Maximum detected toxicity included a G2 GGT increase in two patients (at 1 and 3 months respectively). One patient developed a non-classic RILD with a fivefold increase in transaminase enzymes level and a shift in Child-Pugh category from B7 to C10 due to bilirubin increase. Only one modification in the surgical strategy was needed during LT.

Conclusions

SABR proved to be a safe and effective local therapy prior to LT in HCC patients. Prospective controlled clinical trials are needed to evaluate its efficacy compared to other local therapies in this setting.

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Authors and Affiliations

  1. Department of Oncology, Radiation Oncology, University of Turin School of Medicine, Via Genova 3, 10126, Turin, Italy

    Alessia Guarneri, Pierfrancesco Franco, Elisabetta Trino, Andrea Riccardo Filippi & Umberto Ricardi

  2. Department of Surgical Sciences, Liver Transplantation Center, University of Turin, Turin, Italy

    Renato Romagnoli, Stefano Mirabella, Giorgia Rizza & Mauro Salizzoni

  3. Pathology Unit, Department of Medical Sciences, University of Torino, Turin, Italy

    Luca Molinaro

  4. Department of Gastro-Hepatology, AOU Città della Salute e della Scienza, Turin, Italy

    Patrizia Carucci

Authors
  1. Alessia Guarneri
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  2. Pierfrancesco Franco
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  3. Renato Romagnoli
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  4. Elisabetta Trino
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  5. Stefano Mirabella
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  6. Luca Molinaro
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  7. Giorgia Rizza
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  8. Andrea Riccardo Filippi
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  9. Patrizia Carucci
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  10. Mauro Salizzoni
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  11. Umberto Ricardi
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Corresponding author

Correspondence to Pierfrancesco Franco.

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We declare that we do not have any conflict of interest.

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Informed consent was obtained from all individual participants included in the study.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Guarneri, A., Franco, P., Romagnoli, R. et al. Stereotactic ablative radiation therapy prior to liver transplantation in hepatocellular carcinoma. Radiol med 121, 873–881 (2016). https://doi.org/10.1007/s11547-016-0670-1

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  • DOI: https://doi.org/10.1007/s11547-016-0670-1

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