SBRT for bridging and downstaging HCC before transplant

Area of Science:

• Hepatobiliary Surgery
• Radiation Oncology
• Transplant Surgery

Background:

• Stereotactic body radiotherapy (SBRT) is an emerging treatment for hepatocellular carcinoma (HCC) patients awaiting liver transplantation (LT).
• Limited data exists on the safety and efficacy of SBRT in this specific patient population.
• SBRT is considered for bridging to LT or for downstaging tumors to meet LT criteria.

Purpose of the Study:

• To evaluate the safety and outcomes of SBRT in patients with HCC awaiting LT.
• To assess treatment-related toxicities, liver function changes, and the probability of LT post-SBRT.
• To identify predictors of successful LT following SBRT.

Main Methods:

• Retrospective review of 88 adult patients with HCC who received SBRT between 2004 and 2019.
• Analysis of treatment-related toxicities, liver function decline, and LT probability using competing risk analysis.
• Identification of key predictors for LT, including MELD score, AFP level, and tumor characteristics.

Main Results:

• SBRT was used for bridging in 66% and downstaging in 34% of patients, with mild toxicities observed.
• The probability of LT post-SBRT reached 73% at 2 years, with 69% of patients undergoing LT.
• Predictors of LT included MELD score, AFP, and tumor burden; recurrence rates were higher in the downstaging group.

Conclusions:

• SBRT is a safe and effective bridging therapy for HCC patients awaiting LT.
• The role of SBRT in downstaging HCC is limited due to lower response rates and higher recurrence.
• Careful patient selection is crucial for optimizing SBRT outcomes in HCC management prior to LT.