Stereotactic body radiation therapy (SBRT) for definitive treatment and as a bridge to liver transplantation in early stage inoperable Hepatocellular carcinoma

Abstract

Background and PurposeStereotactic body radiotherapy (SBRT) is an emerging modality for definitive treatment of Hepatocellular carcinoma (HCC).Materials and MethodsThis retrospective study included all early stage HCC patients who were not candidates for primary resection and/or local therapy, treated with SBRT between 11/2011 and 1/2016.ResultsTwenty-three patients were included. The median age was 62 years; 70% males; 30% females; 70% viral hepatitis carriers; 100% cirrhotic; 13 Child Pugh [CP]-A and 10 [CP]-B. The median tumor volume was 12.7cm3 (range, 2.2–53.6 cm3). Treatment was well tolerated. With the exception of one patient who developed RILD, no other patient had significant changes in 12 weeks of laboratory follow-up. SBRT was a bridge to transplantation in 16 patients and 11 were transplanted.. No surgical difficulties or complications were reported following SBRT, and none of the transplanted patients had local progression before transplantation. The median prescribed dose to the tumor was 54Gy (range, 30-54Gy), the median dose to the uninvolved liver was 6.0Gy(range, 1.6–12.6Gy). With a median follow-up time of 12 months, the median overall-survival for the 11 transplanted patients was not reached (range, 2.0–53.7+ months) and was 23 months for the 12 non-transplanted patients. The median progression-free survival for the transplanted patients was not reached (54+ months) and was 14.0 months for the non-transplanted patients. There was no SBRT-related mortality. Liver explant post SBRT revealed pathological complete response in 3(27.3%), pathological partial response in 6(54.5%), and pathological stable disease in 2(18.2%) tumors.ConclusionsSBRT is safe and effective and can be used as a bridge to transplantation without comprising the surgical procedure.

Volumetric modulated arc therapy (VMAT) is superior to intensity modulated radiotherapy (IMRT) for liver sparing in SBRT for hepatocellular carcinoma

“…In our own experience with SBRT for HCC, we reported favorable outcomes using SBRT as de nitive treatment or as a bridge to liver transplantation in pts with early stage inoperable HCC [9]. Median prescribed dose to the tumor was 54 Gy (range, 30-54Gy) with median overall-survival for the transplanted patients not reached and 23 months for the patients who were not transplanted.…”

Preoperative Stereotactic Body Radiotherapy to Portal Vein Tumour Thrombus in Hepatocellular Carcinoma: Clinical and Pathological Analysis

“…Reports, which focus on the post-SBRT pathology are limited. SBRT as a bridging treatment prior to liver transplantation showed a complete pathological response rate of 27-63% [26][27][28][29] . The complete pathological response rate in our study was comparable to that reported in previous studies.…”

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

“…Radiographic local control rates exceed 85% (►Table 1). [84][85][86][87][88][89] In studies assessing for radiographic response only a few months after SBRT, response rates may be lower 90 but are likely underestimations as SBRT response can take up to 6 months or longer. 91 Pathologic response rates were variable, ranging from 37 to 70%.…”

“…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. 93 Surgical complication rates were not increased in patients receiving SBRT as bridge therapy, 85,86,88,93 although one study identified a single patient for whom a modification of surgical approach was needed. 84 Few reports are dedicated to describing the efficacy of SBRT in downstaging patients to become eligible for transplant.…”