Clinical outcome and pathologic correlation of stereotactic body radiation therapy as a bridge to transplantation for advanced hepatocellular carcinoma: a case series

Ying-Fu Wang,Chun-Shu Lin,Jen-Fu Yang,Wen-Yen Huang,Chih-Weim Hsiang,Yang-Hong Dai,Hao-Chih Chang,Cheng-Hsiang Lo,Po-Chien Shen

doi:10.1186/s13014-020-01739-5

Ying-Fu Wang, Chun-Shu Lin + Show 7 more

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https://doi.org/10.1186/s13014-020-01739-5

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Abstract

BackgroundStereotactic body radiotherapy (SBRT) is an emerging modality for hepatocellular carcinoma (HCC). However, there is scant information about its safety and effectiveness in the neoadjuvant setting prior to liver transplantation (LT). We present the clinical outcome and pathologic assessment of SBRT followed by LT for patients with advanced HCC.MethodsThis retrospective study included HCC patients treated with neoadjuvant SBRT prior to LT between 2009 and 2018. Radiographic response and adverse effects, including radiation-induced liver disease (RILD), were evaluated. Pathologic response was assessed by the percentage of tumor necrosis relative to the total tumor volume. Overall survival (OS) and recurrence-free survival (RFS) were calculated using the Kaplan–Meier method.ResultsFourteen patients underwent SBRT for a total of 25 HCC lesions, followed by LT. The median tumor size was 4.45 cm in diameter, and the median prescribed dose was 45 Gy in 5 fractions. SBRT provided significant AFP reduction, 100% infield control, and a 62.5% response rate. The maximum detected toxicity included grade 3 thrombocytopenia and two grade 3–4 hyperbilirubinemia. One patient developed non-classic RILD. Patients were bridged to LT with a median time of 8.4 months after SBRT, and 23.1% of them achieved a complete pathologic response. The median OS and RFS were 37.8 and 18.3 months from the time of LT, respectively.ConclusionsSBRT provides favorable tumor control and acceptable adverse effects for patients awaiting LT. Further prospective studies to test SBRT as a bridging therapy for LT are feasible.

Highlights

Stereotactic body radiotherapy (SBRT) is an emerging modality for hepatocellular carcinoma (HCC)
HCC patients are at risk of tumor progression, making them ineligible for transplantation that involves a long waiting period, which further results in a higher dropout rate compared to nonmalignant candidates (31.8% vs. 19.1% at 1 year) after listing for liver trans‐ plantation (LT) [5]
We retrospectively reviewed the medical records of HCC patients treated with neoadjuvant SBRT in our institution from January 2009 to December 2018

Summary

Introduction

Stereotactic body radiotherapy (SBRT) is an emerging modality for hepatocellular carcinoma (HCC). We present the clinical outcome and pathologic assessment of SBRT followed by LT for patients with advanced HCC. Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy and a leading cause of cancer mortality worldwide [1]. Only a small percentage of HCC patients could receive transplants due to the scarcity of donors and the great number of nonmalignant indications. HCC patients are at risk of tumor progression, making them ineligible for transplantation that involves a long waiting period, which further results in a higher dropout rate compared to nonmalignant candidates (31.8% vs 19.1% at 1 year) after listing for LT [5]. Transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) have been the most commonly used approaches in controlling tumor growth and vascular invasion, with a reportedly low dropout rate of 12.2% [6]

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