Stereotactic body radiotherapy used as a bridge to liver transplant in patients with hepatocellular carcinoma and Child-Pugh score ≥8 cirrhosis
Steven Gresswell, Rachel Tobillo, Shaakir Hasan, Tadahiro Uemura, Lorenzo Machado, Ngoc Thai and Alexander Kirichenko
Introduction: To report on SBRT as a bridge to OLT for patients with HCC and Child-Pugh ≥8 cirrhosis.
Methods: Retrospective review of 15 patients, treated from 2010-2017. Three patients excluded secondary to delisting from prohibitive substance. Twelve patients (17 lesions) included for final analysis. Hepatic SPECT functional treatment planning utilized.
Results: The median age of 60 years with a median CP 9 and MELD 14. The median SBRT dose was 40 Gy in 5 fractions, and median tumor size was 2.3cm (1.2-5.3cm). Median follow-up and survival was 40-months and 46-months, respectively. One patient succumbed to renal/hepatic failure before OLT. Radiographic response was 80%. pCR at explant was 46%. No grade ≥ 3 acute toxicities. Median time to progression of CP ≥ 2 was 9.7-months and MELD progression was not met before OLT.
Conclusion: SBRT with functional treatment planning can be used safely as a bridge to OLT in select patients with CP ≥8 cirrhosis.
Keywords: stereotactic body radiation treatment, hepatocellular carcinoma, bridge to transplant, downsizing, liver transplantation, hepatic cirrhosis