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Title: Role of Stereotactic Body Radiation Therapy Before Orthotopic Liver Transplantation: Retrospective Evaluation of Pathologic Response and Outcomes

Abstract

Purpose: To analyze the results of stereotactic body radiation therapy (SBRT) in patients with early-stage, localized hepatocellular carcinoma who underwent definitive orthotopic liver transplantation (OLT). Methods and Materials: The subjects of this retrospective report are 38 patients diagnosed with hepatocellular carcinoma who underwent SBRT per institutional phase 1 to 2 eligibility criteria, before definitive OLT. Pre-OLT radiographs were compared with pathologic gold standard. Analysis of treatment failures and deaths was undertaken. Results: With median follow-up of 4.8 years from OLT, 9 of 38 patients (24%) recurred, whereas 10 of 38 patients (26%) died. Kaplan-Meier estimates of 3-year overall survival and disease-free survival are 77% and 74%, respectively. Sum longest dimension of tumors was significantly associated with disease-free survival (hazard ratio 1.93, P=.026). Pathologic response rate (complete plus partial response) was 68%. Radiographic scoring criteria performed poorly; modified Response Evaluation Criteria in Solid Tumors produced highest concordance (κ = 0.224). Explants revealed viable tumor in 74% of evaluable patients. Treatment failures had statistically larger sum longest dimension of tumors (4.0 cm vs 2.8 cm, P=.014) and non–statistically significant higher rates of lymphovascular space invasion (44% vs 17%), cT2 disease (44% vs 21%), ≥pT2 disease (67% vs 34%), multifocal tumors at time of SBRT (44% vs 21%), andmore » less robust mean α-fetoprotein response (−25 IU/mL vs −162 IU/mL). Conclusions: Stereotactic body radiation therapy before to OLT is a well-tolerated treatment providing 68% pathologic response, though 74% of explants ultimately contained viable tumor. Radiographic response criteria poorly approximate pathology. Our data suggest further stratification of patients according to initial disease burden and treatment response.« less

Authors:
 [1];  [2];  [3];  [4];  [5];  [6];  [7];  [8];  [9];  [10]
  1. Department of Radiation Oncology, Slidell Memorial Hospital Regional Cancer Center, Slidell, Louisiana (United States)
  2. Department of Radiation Oncology, Schneck Medical Center, Seymour, Indiana (United States)
  3. Department of Radiation Oncology, Mercy Hospital, Oklahoma City, Oklahoma (United States)
  4. Department of Radiation Oncology, St. Francis Healthcare, Cape Girardeau, Missouri (United States)
  5. Department of Radiation Oncology, Community Hospital Anderson, Anderson, Indiana (United States)
  6. Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana (United States)
  7. Department of Radiation Oncology, Columbus Regional, Columbus, Indiana (United States)
  8. Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana (United States)
  9. Department of Surgery, University of Alabama-Birmingham, Birmingham, Alabama (United States)
  10. Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana (United States)
Publication Date:
OSTI Identifier:
22649882
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 97; Journal Issue: 5; Other Information: Copyright (c) 2017 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BIOMEDICAL RADIOGRAPHY; IMAGES; LIVER; NEOPLASMS; PATHOLOGY; PATIENTS; RADIOTHERAPY

Citation Formats

Mannina, Edward Michael, E-mail: emmannina@gmail.com, Cardenes, Higinia Rosa, Lasley, Foster D., Goodman, Benjamin, Zook, Jennifer, Althouse, Sandra, Cox, John Alvin, Saxena, Romil, Tector, Joseph, and Maluccio, Mary. Role of Stereotactic Body Radiation Therapy Before Orthotopic Liver Transplantation: Retrospective Evaluation of Pathologic Response and Outcomes. United States: N. p., 2017. Web. doi:10.1016/J.IJROBP.2016.12.036.
Mannina, Edward Michael, E-mail: emmannina@gmail.com, Cardenes, Higinia Rosa, Lasley, Foster D., Goodman, Benjamin, Zook, Jennifer, Althouse, Sandra, Cox, John Alvin, Saxena, Romil, Tector, Joseph, & Maluccio, Mary. Role of Stereotactic Body Radiation Therapy Before Orthotopic Liver Transplantation: Retrospective Evaluation of Pathologic Response and Outcomes. United States. doi:10.1016/J.IJROBP.2016.12.036.
Mannina, Edward Michael, E-mail: emmannina@gmail.com, Cardenes, Higinia Rosa, Lasley, Foster D., Goodman, Benjamin, Zook, Jennifer, Althouse, Sandra, Cox, John Alvin, Saxena, Romil, Tector, Joseph, and Maluccio, Mary. Sat . "Role of Stereotactic Body Radiation Therapy Before Orthotopic Liver Transplantation: Retrospective Evaluation of Pathologic Response and Outcomes". United States. doi:10.1016/J.IJROBP.2016.12.036.
@article{osti_22649882,
title = {Role of Stereotactic Body Radiation Therapy Before Orthotopic Liver Transplantation: Retrospective Evaluation of Pathologic Response and Outcomes},
author = {Mannina, Edward Michael, E-mail: emmannina@gmail.com and Cardenes, Higinia Rosa and Lasley, Foster D. and Goodman, Benjamin and Zook, Jennifer and Althouse, Sandra and Cox, John Alvin and Saxena, Romil and Tector, Joseph and Maluccio, Mary},
abstractNote = {Purpose: To analyze the results of stereotactic body radiation therapy (SBRT) in patients with early-stage, localized hepatocellular carcinoma who underwent definitive orthotopic liver transplantation (OLT). Methods and Materials: The subjects of this retrospective report are 38 patients diagnosed with hepatocellular carcinoma who underwent SBRT per institutional phase 1 to 2 eligibility criteria, before definitive OLT. Pre-OLT radiographs were compared with pathologic gold standard. Analysis of treatment failures and deaths was undertaken. Results: With median follow-up of 4.8 years from OLT, 9 of 38 patients (24%) recurred, whereas 10 of 38 patients (26%) died. Kaplan-Meier estimates of 3-year overall survival and disease-free survival are 77% and 74%, respectively. Sum longest dimension of tumors was significantly associated with disease-free survival (hazard ratio 1.93, P=.026). Pathologic response rate (complete plus partial response) was 68%. Radiographic scoring criteria performed poorly; modified Response Evaluation Criteria in Solid Tumors produced highest concordance (κ = 0.224). Explants revealed viable tumor in 74% of evaluable patients. Treatment failures had statistically larger sum longest dimension of tumors (4.0 cm vs 2.8 cm, P=.014) and non–statistically significant higher rates of lymphovascular space invasion (44% vs 17%), cT2 disease (44% vs 21%), ≥pT2 disease (67% vs 34%), multifocal tumors at time of SBRT (44% vs 21%), and less robust mean α-fetoprotein response (−25 IU/mL vs −162 IU/mL). Conclusions: Stereotactic body radiation therapy before to OLT is a well-tolerated treatment providing 68% pathologic response, though 74% of explants ultimately contained viable tumor. Radiographic response criteria poorly approximate pathology. Our data suggest further stratification of patients according to initial disease burden and treatment response.},
doi = {10.1016/J.IJROBP.2016.12.036},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 5,
volume = 97,
place = {United States},
year = {Sat Apr 01 00:00:00 EDT 2017},
month = {Sat Apr 01 00:00:00 EDT 2017}
}