Background: Transarterial chemoembolization (TACE) or radiofrequency ablation are often used as local Hepatocellular Carcinoma (HCC) treatment while waiting for a liver transplant (LTx). However, it is reported that more than 20% of patients drop off from the LTx list because of tumor progression. We have introduced stereotactic body radiotherapy (SBRT) for HCC as a bridge therapy to LTx.

Methods and patients: 21 HCC patients underwent SBRT (17 SBRT alone and 4 SBRT+TACE) while waiting for LTx from January 2010 to December 2015. Nineteen patients underwent deceased donor LTx. SBRT was defined as 40-50Gy with 4-6 fractions. The dropout rate and tumor response to SBRT were analyzed along with pre- and post-transplant outcome.

Results: Median original tumor size was 2.8cm (2.0-6.2) and median tumor size after SBRT was significantly smaller 1.0cm (0-3.5) in explanted livers (p<0.01) (Figure 1). Median wait time for LTx was 237 days (55-1083). Median follow up after LTx was 883 days (0-2314). Only two patients dropped off the list due to de novo lesions of HCC, and the drop out rate was 9 %. SBRT was well tolerated and there was no acute toxicity of grade 3 or above. Only 1 patient had progression of Child-Pugh score from A to B in 6 months post SBRT. Five out of 19 explanted livers showed complete pathologic response and 14 patients had residual tumors with partial responses. Patient survival was 89% at 1 year and 76% at 5 year with excluded preoperative mortality in one month (Figure 2). Only one patient experienced HCC recurrence post LTx, and the patient had downsized HCC to within Milan criteria.

Discussion: SBRT can control HCC with minimal dropout and minimal recurrence post-liver transplant. SBRT appears safe, effective treatment for HCC on the LTx waiting list.

CITATION INFORMATION: Uemura T, Kirichenko A, Bunker M, Vincent M, Machado L, Singhal A, Thai N. A New Strategy for Loco-Regional Therapy of Hepatocellular Carcinoma: Stereotactic Body Radiotherapy as a Bridge to Liver Transplantation. Am J Transplant. 2017;17 (suppl 3).

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