Twenty seven (27) pts with HCC and cirrhosis have been treated with SBRT with intent for liver transplantation since 2010 at Allegheny Health Network. Nineteen (19) pts within Milan Criteria were treated with SBRT as a bridge to transplantation. Eight (8) pts were outside of Milan Criteria and were down-sized to Milan criteria and listed for liver transplant. Eighteen (18) pts were classified with Child's B cirrhosis, while 9 had Child's A cirrhosis. There were no Child's C cirrhosis in this group. There were no serious complications after SBRT and no acute hepatic decompensation observed after SBRT

In the bridge-to-transplant group, 18/19 (95%) pts were successfully controlled with SBRT. One (1) pt had HCC progression in the non-treated portion of liver at 9 months after SBRT. 13/19 (68%) underwent liver transplant at 1-23 mos intervals after SBRT, 5 are still listed for transplant without evidence of recurrence. There has been no recurrence post-transplant in the 13 pts with follow-up of 3 mos to 4.5 yrs. Pathology of explanted livers showed 13/13 reduction of tumor and 7/13 with no residual tumors.

In the down-sized group, 8/8 were successfully down-sized to within Milan Criteria; however, 3 eventually developed HCC recurrence outside of treatment area. Three (3) pts underwent liver transplantation without HCC recurrence post-transplant at 9 mos, 2.5 and 3 yr follow-up. Two (2) pts are still on the list awaiting liver transplants (6 mos, 2 yrs post-SBRT). All three explanted livers showed no residual HCC on pathology.

SBRT is a highly effective modality for the treatment of HCC as bridge or to down-size to liver transplantation. Overall success in bridge-to-transplant was 95% and down-sizing was 63%. Tumor response to SBRT was 100% and local tumor control was 100%. There were no significant complications with SBRT.

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