Stereotactic ablative body radiotherapy as a bridge to liver transplantation for hepatocellular carcinoma: Başkent university experience
Guler Yavas1, Ebru H. Ayvazoglu Soy2, Mehmet Coskun3, Cem Onal1, Fatih Boyvat4, Mehmet Haberal1.
1Department of Radiation Oncology, Baskent University, Ankara, Turkey; 2Department of General Surgery, Division of Transplantation, Baskent University, Ankara, Turkey; 3Department of Radiology, Baskent University, Ankara, Turkey; 4Department of Radiology, Division of Interventional Radiology, Baskent University, Ankara, Turkey
Aim: Hepatocellular carcinoma (HCC) is the most common primary liver tumor. The only curative treatment options remain to be liver transplantation and resection. However approximately 20–30% of the patients have substantial disease progression while still awaiting transplantation. Herein, we report our experience on stereotactic ablative body radiotherapy (SABR) as a bridge to liver transplantation for HCC.
Methods and Materials: We retrospectively evaluated 63 pathologically proven HCC patients who received liver-directed therapy (38 resection, 38 TACE, 27 RFA) while waiting for liver transplant with a mean 74,081 ± 8,732 months of disease free survival. SABR was applied to nine lesions (total diameter ≤6 cm and at least 1 cm away from GIS mucosa or chest wall) in seven Child B HCC patients (with Karnofsky Performance Status ≥70 and no extrahepatic metastases) as a bridge treatment to transplantation. Radiographic response was based on magnetic resonance imaging evaluation at one month after SABR. All patients were assessed evaluated throughout the course of SABR, one month after completion, and at 3-month intervals for the first two years following SABR.
Results: The median age of SABR patients was 65 years (range: 63-71 years) and the median SBRT dose was 45 Gy (range: 30-54 Gy) delivered in 3-5 fractions. The median tumor diameter was 17 mm (range: 12-30 mm). All patients received liver-directed therapies prior to SABR. The median follow-up period was 10 months (range, 2-16 months). Six lesions (66.7%) had a complete response, and 3 patients are still alive with no evidence of disease. The acute toxicity was negligible and all patients completed the course as planned.
Conclusion: Our results suggested that SABR is a feasible, effective and safe bridging therapy option for HCC patients while waiting for liver transplant.
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