We are upgrading the repository! A content freeze is in effect until December 6, 2024. New submissions or changes to existing items will not be allowed during this period. All content already published will remain publicly available for searching and downloading. Updates will be posted in the Website Upgrade 2024 FAQ in the sidebar Help menu. Reach out to escholarship@umassmed.edu with any questions.
Outcomes After Stereotactic Body Radiation Therapy as a Bridging Modality to Liver Transplantation for Hepatocellular Carcinoma
Name:
Publisher version
View Source
Access full-text PDFOpen Access
View Source
Check access options
Check access options
Authors
Garg, RashiFoley, Kim
Movahedi, Babak
Masciocchi, Mark
Bledsoe, Jacob R.
Ding, Linda
Rava, Paul
FitzGerald, Thomas J
Sioshansi, Shirin
UMass Chan Affiliations
Department of Radiation OncologyDepartment of Pathology
Department of Radiology
Department of Family Medicine and Community Health
Document Type
Journal ArticlePublication Date
2020-09-14Keywords
hepatocellular carcinomaliver transplantation
stereotactic body radiation therapy
SBRT
Neoplasms
Oncology
Radiation Medicine
Radiology
Surgery
Surgical Procedures, Operative
Metadata
Show full item recordAbstract
Purpose: For patients with hepatocellular carcinoma awaiting liver transplantation (LT), stereotactic body radiation therapy (SBRT) has emerged as a bridging treatment to ensure patients maintain priority status and eligibility per Milan criteria. In this study, we aimed to determine the efficacy and safety of SBRT in such situations. Methods and Materials: A retrospective analysis was conducted of the outcomes of 27 patients treated with SBRT who were listed for LT at 1 institution. Among these, 20 patients with 26 tumors went on to LT and were the focus of this study. Operative reports and postoperative charts were evaluated for potential radiation-related complications. The explant pathology findings were correlated with equivalent dose in 2 Gy fractions and tumor size. Results: Median pretreatment tumor size was 3.05 cm. Median total dose of radiation was 50 Gy delivered in 5 fractions. Pathologic complete response (pCR) was achieved in 16 tumors (62%). Median interval from end of SBRT to transplant was 287 days. Of the 21 tumors imaged before transplant, 16 or 76% demonstrated a clinical complete response based on modified Response Evaluation Criteria in Solid Tumors criteria. There was no significant correlation between pCR rate and increasing tumor size (odds ratio [OR], 0.95; 95% confidence interval, 0.595-1.53) or pCR rate and equivalent dose in 2 Gy fractions (OR, 1.03; 95% confidence interval, 0.984-1.07.) No patients experienced radiation-related operative or postoperative complications. Of the 27 patients who were listed for transplant, the dropout rate was 22%. Two of the 5 patients with Child-Pugh score 10 died of liver failure. Conclusions: These data demonstrate that SBRT as a bridging modality is a feasible option, with a pCR rate comparable to that of other bridging modalities and no additional radiation-related operative or postoperative complications. There was no dose dependence nor size dependence for pCR rate, which may indicate that for the tumor sizes in this study, the radiation doses delivered were sufficiently high.Source
Garg R, Foley K, Movahedi B, Masciocchi MJ, Bledsoe JR, Ding L, Rava P, Fitzgerald TJ, Sioshansi S. Outcomes After Stereotactic Body Radiation Therapy as a Bridging Modality to Liver Transplantation for Hepatocellular Carcinoma. Adv Radiat Oncol. 2020 Sep 14;6(1):100559. doi: 10.1016/j.adro.2020.08.016. PMID: 33665482; PMCID: PMC7897771. Link to article on publisher's site
DOI
10.1016/j.adro.2020.08.016Permanent Link to this Item
http://hdl.handle.net/20.500.14038/48502PubMed ID
33665482Related Resources
Rights
Copyright © 2020 The Authors. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Distribution License
http://creativecommons.org/licenses/by-nc-nd/4.0/ae974a485f413a2113503eed53cd6c53
10.1016/j.adro.2020.08.016
Scopus Count
Collections
Except where otherwise noted, this item's license is described as Copyright © 2020 The Authors. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).