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World Journal of Surgery

, Volume 43, Issue 3, pp 886–893 | Cite as

Stereotactic Body Radiation Therapy: A New Strategy for Loco-Regional Treatment for Hepatocellular Carcinoma While Awaiting Liver Transplantation

  • Tadahiro UemuraEmail author
  • Alexander Kirichenko
  • Mark Bunker
  • Molly Vincent
  • Lorenzo Machado
  • Ngoc Thai
Original Scientific Report (including Papers Presented at Surgical Conferences)

Abstract

Background

Trans-arterial chemoembolization and radiofrequency ablation are commonly used for control of hepatocellular carcinoma (HCC) on liver transplant (LTx) waiting list. Stereotactic body radiation therapy (SBRT) was introduced to our institution for HCC as a bridging or downsizing therapy to LTx.

Patients and methods

Twenty-five HCC lesions in 22 patients were treated with SBRT while waiting for LTx from January 2010 to December 2015. Nineteen of these patients received deceased donor LTx. SBRT was defined as 40–50 Gy delivered in 4–6 fractions. Pre- and post-liver transplant outcome were analyzed in addition to the dropout rate and tumor response to SBRT.

Results

Median size of original tumors was 3.2 cm (2.0–8.9), and median size of tumor after SBRT was significantly smaller at 0.9 cm (0–3.2) in the explanted livers (p < 0.01). The dropout rate was 9%, and they were only downsized patients outside of Milan criteria. Liver disease did not progress between pre- and post-SBRT except one patient. Twenty-eight percent of treated HCCs showed complete pathologic response, and 22% had extensive partial response with some residual tumor. No HCC recurrence was experienced after LTx.

Conclusion

SBRT is indicated to be safe, effective treatment for HCC on LTx waiting list, and it leads to satisfactory post-liver transplant outcomes.

Abbreviations

TACE

Trans-arterial chemoembolization

HCC

Hepatocellular carcinoma

SBRT

Stereotactic body radiation therapy

RFA

Radiofrequency ablation

RILD

Radiation induced liver disease

MELD

Model for end-stage liver disease

PTV

Planned target volume

AFP

Alpha fetoprotein

Notes

Compliance with ethical standards

Conflict of interest

The authors who have taken part in this study declared that they do not have anything to disclose regarding conflict of interest with respect to this manuscript.

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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Tadahiro Uemura
    • 1
    Email author
  • Alexander Kirichenko
    • 2
  • Mark Bunker
    • 3
  • Molly Vincent
    • 1
  • Lorenzo Machado
    • 1
  • Ngoc Thai
    • 1
  1. 1.Department of Surgery, Abdominal Transplantation and Hepato-Biliary SurgeryAllegheny General HospitalPittsburghUSA
  2. 2.Radiation OncologyAllegheny General HospitalPittsburghUSA
  3. 3.PathologyAllegheny General HospitalPittsburghUSA

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