Abstract
Lymph node metastases from hepatocellular carcinoma (HCC) represents a challenging clinical scenario with a poor prognosis, especially in the setting of prior liver transplant. Long-term survival is achievable in select patients with isolated lymph node metastases who undergo surgical resection, but little data exist regarding non-surgical options. For intrahepatic HCC, stereotactic body radiation therapy (SBRT) has emerged as a standard and effective nonsurgical treatment option. Here, we present three patients (two with prior liver transplant) with isolated lymph node metastases treated with curative intent using SBRT to doses of 30-45 Gy in three to five fractions. Two patients (with follow-up of 27 and 31 months) had a complete or near-complete response and remain cancer-free. One patient had intrahepatic HCC recurrence shortly after SBRT but stable disease in the treated lymph node metastasis at 20 months. Liver function remained excellent after radiation in all three patients, but one patient developed a grade 3 duodenal ulcer at 20 months that resolved with medical management. These cases illustrate the potential utility of SBRT as a non-invasive, definitive treatment option for patients with isolated lymph node metastases from HCC.
Highlights
Lymph node metastases (LNM) occur in approximately half of hepatocellular carcinoma (HCC) patients with extrahepatic spread [1], and these patients have a median survival of less than one year [1]
Many patients are not candidates for surgery and little data exist regarding effective non-surgical options. The purpose of this case series is to report the capability of stereotactic body radiation (SBRT) to achieve similar long-term results in patients with isolated HCC LNM
With local control rates of 70-80% even for large tumors, SBRT demonstrates equivalent and potentially superior safety and efficacy compared to other liver-directed treatments such as trans-arterial chemoembolization (TACE) or thermal ablation, provided that radiation dose to surrounding hepatic tissue is minimized and pretreatment liver function is taken into consideration [5,6,7]
Summary
Lymph node metastases (LNM) occur in approximately half of hepatocellular carcinoma (HCC) patients with extrahepatic spread [1], and these patients have a median survival of less than one year [1]. Many patients are not candidates for surgery and little data exist regarding effective non-surgical options. The purpose of this case series is to report the capability of stereotactic body radiation (SBRT) to achieve similar long-term results in patients with isolated HCC LNM. Though the role of radiation therapy for LNM from HCC has traditionally been minimal and limited to palliation, SBRT allows for the precise delivery of ablative radiation doses in three to five treatment sessions with the potential of long-term disease control. We present a series of three patients treated using SBRT with curative intent for isolated, recurrent LNM from HCC, including two patients with a history of liver transplantation
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