HDR Brachytherapy and SBRT as Bridging Therapy to Liver Transplantation in HCC Patients: A Single-Center Experience.

Franziska Walter,Jens Neumann,Frederik Fuchs,Jens Ricke,Markus Guba,Lukas Nierer,Max Seidensticker,Claus Belka,Sabine Gerum,Stefanie Corradini,Enrico N De Toni,Maya C Rottler,Robert Erdelkamp

doi:10.3389/fonc.2021.717792

Franziska Walter, Jens Neumann + Show 11 more

Open Access

https://doi.org/10.3389/fonc.2021.717792

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Abstract

BackgroundIn the treatment of patients with HCC awaiting liver transplantation (LT), local ablative treatments (LAT) are available either for downstaging or as bridging treatment. We present our clinical experience with both available radiation-based techniques, brachytherapy (BT), and stereotactic body radiotherapy (SBRT).MethodsAll patients diagnosed with HCC and who were treated with BT or SBRT at our institution between 2011 and 2018 were retrospectively reviewed. The current analysis included all patients who subsequently underwent LT.ResultsA total of 14 patients (male=9; female=5) were evaluated. Seven underwent BT for bridging before LT, and seven were treated with SBRT. BT was performed with a prescribed dose of 1 × 15 Gy, while SBRT was applied with 37 Gy (65%-iso) in three fractions in six patients, and one patient was treated with 54 Gy (100%-iso) in nine fractions. The treatment was generally well tolerated. One case of grade 3 bleeding was reported after BT, and one case of liver failure occurred following SBRT. All patients underwent LT after a median time interval of 152 days (range 47–311) after BT and 202 days (range 44–775) following SBRT. In eight cases, no viable tumor was found in the explanted liver, while four liver specimens showed vital tumor. The median follow-up after SBRT was 41 months and 17 months following BT. Overall, no hepatic HCC recurrence occurred following LT.ConclusionBoth SBRT and BT are feasible and well tolerated as bridging to LT when applied with caution in patients with impaired liver function. Radiation-based treatments can close the gap for patients not suitable for other locally ablative treatment options.

Highlights

Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and mostly develops on the background of preexisting liver cirrhosis or chronic liver disease [1]
While patients within the Milan criteria are considered eligible for primary liver transplantation (LT), patients outside the Milan criteria may be considered for LT based on an individual evaluation that includes the response to local ablative treatment (LAT) [4]
We retrospectively reviewed all patients diagnosed with HCC and who were treated with BT or stereotactic body radiotherapy (SBRT) between 2011 and 2018 in our institution

Summary

Introduction

Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and mostly develops on the background of preexisting liver cirrhosis or chronic liver disease [1]. The treatment of HCC is stage dependent and determined by several variables, including liver function and performance status of patients, in addition to the number and size of lesions. The prognosis of patients undergoing LT due to HCC has greatly improved after the introduction of the Milan criteria [2], which determines eligibility for LT based on the maximal number and size of HCC lesions. While patients within the Milan criteria are considered eligible for primary LT, patients outside the Milan criteria may be considered for LT based on an individual evaluation that includes the response to local ablative treatment (LAT) [4]. In the treatment of patients with HCC awaiting liver transplantation (LT), local ablative treatments (LAT) are available either for downstaging or as bridging treatment. We present our clinical experience with both available radiation-based techniques, brachytherapy (BT), and stereotactic body radiotherapy (SBRT)

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