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Updated: Jun 24, 2025

Treatment of Liver Metastases Using an Internal Target Volume Method for Stereotactic Body Radiotherapy
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Stereotactic Body Radiotherapy and Liver Transplant for Liver Cancer: A Nonrandomized Controlled Trial.

Victor Ho-Fun Lee1,2, Varut Vardhanabhuti3, Tiffany Cho-Lam Wong4,5

  • 1Department of Clinical Oncology, Centre of Cancer Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.

JAMA Network Open
|June 10, 2024
PubMed
Summary

Stereotactic body radiotherapy (SBRT) shows promising survival and safety for hepatocellular carcinoma (HCC) patients awaiting liver transplant. This approach offers effective tumor control and positive outcomes for unresectable HCC.

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Area of Science:

  • Hepatobiliary oncology
  • Radiation oncology
  • Transplant surgery

Background:

  • Hepatocellular carcinoma (HCC) poses a significant challenge, particularly unresectable cases.
  • The efficacy and safety of stereotactic body radiotherapy (SBRT) as a bridge to deceased donor liver transplant (DDLT) for HCC remain under investigation.

Purpose of the Study:

  • To assess the feasibility and outcomes of SBRT administered before DDLT in patients with previously untreated, unresectable HCC.
  • To evaluate survival rates, objective response rates (ORRs), and safety profiles.

Main Methods:

  • A phase 2, nonrandomized trial involving 32 patients with unresectable HCC.
  • Patients received SBRT (35-50 Gy in 5 fractions) followed by DDLT when available.
  • Dual-tracer PET-CT and MRI were used for imaging before and after SBRT.

Main Results:

  • Median progression-free survival (PFS) was 17.6 months, and median overall survival (OS) was 60.5 months.
  • Five-year PFS was 39.9%, and 5-year OS was 51.3%.
  • Objective response rates varied by criteria, with PERCIST showing 78.1% ORR in patients and 87.5% in lesions. SBRT-related toxic effects were observed in 28.1% of patients, with one grade 3 event.

Conclusions:

  • SBRT as a bridge to DDLT demonstrates promising survival and safety outcomes for unresectable HCC.
  • Pretreatment metabolic tumor volume and complete metabolic response by PERCIST were associated with PFS and OS.
  • Further investigation through randomized clinical trials is warranted.