Stereotactic ablative radiation therapy prior to liver transplantation in hepatocellular carcinoma

Abstract

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.

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

“…Given that AFP levels > 500 ng/mL were predictive of poor survival outcomes for patients within or beyond the Milan criteria, AFP level was also incorporated for decision-making purposes [20]. In present study, SBRT still provided significant AFP reduction, 100% infield control, and 62.5% response rate, which were similar to the published series [9,[11][12][13][14]16]. Five patients either underwent downstaging or were kept from dropout, and all 14 patients successfully underwent LT with a median duration from SBRT to LT of 8.4 months, which was longer than that reported in other series [9, 11-14, 16, 17].…”

“…There is considerable variation among the pathologic complete response rates reported in previous studies. Guarneri et al achieved a 61.5% pathologic complete response after neoadjuvant SBRT [13], whereas in a study by Sapisochin et al, it was only 13.3% [17]. In our cohort, three of the 13 (23.1%) evaluable patients achieved complete tumor necrosis upon pathological analysis.…”

“…However, each modality is limited by the tumor size, number, and location, the adjacent critical organs, the liver function, and the patient's general condition. SBRT has been developed as an effective noninvasive bridge treatment with excellent tumor control and tolerable side effects (Table 4) in several observational studies [9][10][11][12][13][14][15][16], with doses of 30-54 Gy in 3-6 fractions. SBRT provides a low dropout rate and achieves a complete necrosis rate of 27-61.5% of the treated lesions, resulting in favorable overall and disease-free survival after LT.…”

“…SBRT was reported to achieve a 2-year local control rate of 74-100% and overall survival rate of 34-68.7% that are comparable with outcomes after RFA and TACE [8]. However, the effectiveness and safety of SBRT in the neoadjuvant setting are still under investigation [9][10][11][12][13][14][15][16][17], and information on clinical outcomes and pathological responses after irradiation are still scarce. Here, we report the clinical outcomes of neoadjuvant SBRT followed by LT for patients with advanced HCC, as well as the pathologic evaluation of HCC lesions treated with radiotherapy.…”

Radiation Therapy in HCC: What Data Exist and What Data Do We Need to Incorporate into Guidelines?

“…This is despite patient selection enriched for those with larger tumor size, more challenging tumor location, or poorer liver function. Reported grade 3 toxicities ranged from 0 86,89,90,94 to 35%, 84,87,92,95 with the most common toxicity as elevated liver enzymes. Compared with other liver-directed therapies, SBRT was associated with lower toxicity and decreased hospitalization days 96 but tended to cause more liver function impairment.…”