Stereotactic Hypofractionated Radiation Therapy as a Bridge to Transplantation for Hepatocellular Carcinoma: Clinical Outcome and Pathologic Correlation

Journal Article · Sun Jul 01 04:00:00 EDT 2012 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2011.08.032· OSTI ID:22058894

Chawla, Sheema ^[1]; Qu, Zhenhong ^[2]; Kashyap, Randeep ^[3]; Milano, Michael T ^[1]; Hezel, Aram F ^[4]

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1. Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York (United States)
2. Anatomic Pathology, William Beaumont Hospital, Royal Oak, Michigan (United States)
3. Department of Solid Organ Transplant, University of Rochester Medical Center, Rochester, New York (United States)
4. Department of Medicine, Division of Hematology and Oncology, University of Rochester Medical Center, Rochester, New York (United States)

Purpose: We sought to determine efficacy, safety, and outcome of stereotactic hypofractionated radiation therapy (SHORT) as a suitable bridging therapy for patients awaiting liver transplantation (LT) for hepatocellular carcinoma (HCC). We also examined histological response to radiation in the resected or explanted livers. Methods and Materials: Between August 2007 and January 2009, 18 patients with 21 lesions received SHORT. A median total dose of 50 Gy was delivered in 10 fractions. Three patients underwent either chemoembolization (n = 1) or radiofrequency ablation (n = 2) prior to SHORT. Radiographic response was based on computed tomography evaluation at 3 months after SHORT. Histological response as a percentage of tumor necrosis was assessed by a quantitative morphometric method. Results: Six of 18 patients were delisted because of progression (n = 3) or other causes (n = 3). Twelve patients successfully underwent major hepatic resection (n = 1) or LT (n = 11) at a median follow-up of 6.3 months (range, 0.6-11.6 months) after completion of SHORT. No patient developed gastrointestinal toxicity Grade {>=}3 or radiation-induced liver disease. Ten patients with 11 lesions were evaluable for pathological response. Two lesions had 100% necrosis, three lesions had {>=}50% necrosis, four lesions had {<=}50% necrosis, and two lesions had no necrosis. All patients were alive after LT and/or major hepatic resection at a median follow-up of 19.6 months. Conclusions: SHORT is an effective bridging therapy for patients awaiting LT for HCC. It provides excellent in-field control with minimal side effects, helps to downsize or stabilize tumors prior to LT, and achieves good pathological response.

• OSTI ID: 22058894
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 3 Vol. 83; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ABLATION
COMPUTERIZED TOMOGRAPHY
EVALUATION
HEPATOMAS
LIVER
NECROSIS
PATIENTS
RADIATION DOSES
RADIOTHERAPY
RADIOWAVE RADIATION
SAFETY
SIDE EFFECTS
TOXICITY