Prospective Study of Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma on Waitlist for Liver Transplant

Wong, Tiffany Cho‐Lam; Lee, Victor; Law, Ada; Pang, Herbert; Lam, Ka‐On; Lau, Vince; Cui, Tracy Y S; Fong, Adrianna Sze-Yin; Lee, Sarah Wai-Man; Wong, Edwin Chun-Yin; Dai, Jeff; Chan, Albert; Cheung, Tan‐To; Fung, James; Yeung, Richie; Luk, Mai‐Yee; Leung, TW; Lo, Chung‐Mau

doi:10.1002/hep.31992

Cited by 48 publications

(37 citation statements)

References 43 publications

(86 reference statements)

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“…SBRT was demonstrated to be safe, with a significantly higher tumor control rate and reduced risk of waitlist dropout. The Authors concluded that SBRT should be used as an alternative to conventional bridging therapies [ 88 ].…”

Section: Treatments For Bridging and Downstagingmentioning

confidence: 99%

Locoregional Treatments for Bridging and Downstaging HCC to Liver Transplantation

Crocetti

Bozzi

Scalise

et al. 2021

Cancers

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Liver transplantation (LT) is the first-line treatment for patients diagnosed with unresectable early-stage hepatocellular carcinoma (HCC) in the setting of cirrhosis. It is well known that HCC patients within the Milan criteria (solitary tumour ≤ 5 cm or ≤3 tumours, each <3 cm) could undergo LT with excellent results. However, there is a growing tendency to enlarge inclusion criteria since the Milan criteria are nowadays considered too restrictive and may exclude patients who would benefit from LT. On the other hand, there is a persistent shortage of donor organs. In this scenario, there is consensus about the role of loco-regional therapy (LRT) during the waiting list to select patients who would benefit more from LT, reducing the risk of drop off from the waiting list as well as decreasing tumour dimension to meet acceptable criteria for LT. In this review, current evidence on the safety, efficacy and utility of LRTs as neoadjuvant therapies before LT are summarized.

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Section: Treatments For Bridging and Downstagingmentioning

confidence: 99%

Locoregional Treatments for Bridging and Downstaging HCC to Liver Transplantation

Crocetti

Bozzi

Scalise

et al. 2021

Cancers

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“…The frequency of complete pathological necrosis of the tumor after SBRT varies from 13.3% to 61.5% [ 101 , 117 , 118 ]. Wong et al [ 119 ] reported that pre-transplant SBRT had a higher frequency of complete pathological necrosis and a lower frequency of drop-outs from the waiting list compared to conventional bridging therapy.…”

Section: Variations Of Pre-transplant Locoregional Therapiesmentioning

confidence: 99%

Role of Pretransplant Treatments for Patients with Hepatocellular Carcinoma Waiting for Liver Transplantation

Ogawa

Takada

2022

Cancers

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Recently, there have been many reports of the usefulness of locoregional therapy such as transarterial chemoembolization and radiofrequency ablation for hepatocellular carcinoma (HCC) as pretreatment before liver transplantation (LT). Locoregional therapy is performed with curative intent in Japan, where living donor LT constitutes the majority of LT due to the critical shortage of deceased donors. However, in Western countries, where deceased donor LT is the main procedure, LT is indicated for early-stage HCC regardless of liver functional reserve, and locoregional therapy is used for bridging until transplantation to prevent drop-outs from the waiting list or for downstaging to treat patients with advanced HCC who initially exceed the criteria for LT. There are many reports of the effect of bridging and downstaging locoregional therapy before LT, and its indications and efficacy are becoming clear. Responses to locoregional therapy, such as changes in tumor markers, the avidity of FDG-PET, etc., are considered useful for successful bridging and downstaging. In this review, the effects of bridging and downstaging locoregional therapy as a pretransplant treatment on the results of transplantation are clarified, focusing on recent reports.

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“…We appreciate the interests and comments by Sahai et al The median dose of stereotactic body radiation therapy (SBRT) of our patients was 50 Gy (range 30–50 Gy). [ 1 ] In addition, the maximum dose of planning target volume was usually set at 130% of the prescribed dose, which ranged from 108% to 130% of the prescribed dose in our study.…”

mentioning

confidence: 99%

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Lee

Wong

2022

Hepatology

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We appreciate the interests and comments by Sahai et al. The median dose of stereotactic body radiation therapy (SBRT) of our patients was 50 Gy (range 30-50 Gy). [1] In addition, the maximum dose of planning target volume was usually set at 130% of the prescribed dose, which ranged from 108% to 130% of the prescribed dose in our study.We are fully aware that a threshold of radiation dose for more than 700 or 800 cc of the uninvolved liver (i.e., liver minus gross tumor volume [GTV]) was set in other publications. It was not mandatory in our study, provided that the liver minus GTV mean dose, our priority criteria, was met. All patients had the same liver minus GTV dose constraints, regardless of their Child-Pugh status. Similarly, the Radiation Therapy Oncology Group (RTOG) 1112 protocol does not request that the radiation dose for more than 700 or 800 cc of the uninvolved liver must be met before SBRT is considered. [2] All of our patients treated with SBRT did not experience any serious adverse events or radiation-induced liver injury.We also thanked the readers for pointing out the minor differences in the eligibility criteria between the RTOG 1112 and our protocol. Although the eligibility criteria for SBRT in our study mostly followed the RTOG 1112 protocol, we loosened some eligibility criteria and accepted patients with platelet count of ≥ 20 × 10 9 /L (≥ 70 × 10 9 /L in RTOG protocol), serum albumin ≥ 25 g/L (≥28 g/L in RTOG protocol), and Child-Pugh score ≤ B8 (≤ A6 in RTOG protocol). Our previous experience revealed that these patients were safe to undergo SBRT.Finally, there was no specific dose constraint to skin in our study, as we considered it a minor concern. The maximum dose to the skin was 28.64 Gy. None developed skin toxicity after SBRT. Overall, we have shown that SBRT was safe with such slightly loosened criteria and that no patient developed grade ≥ 3 radiationassociated gastrointestinal and skin toxicity after SBRT.

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Prospective Study of Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma on Waitlist for Liver Transplant

Cited by 48 publications

References 43 publications

Locoregional Treatments for Bridging and Downstaging HCC to Liver Transplantation

Locoregional Treatments for Bridging and Downstaging HCC to Liver Transplantation

Role of Pretransplant Treatments for Patients with Hepatocellular Carcinoma Waiting for Liver Transplantation

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