3523 - Stereotactic Body Radiation Therapy (SBRT) for Hepatocellular Carcinoma (HCC) with and without Liver Transplant in Patients with Advanced Hepatic Cirrhosis.
Presenter(s)
P. Shamsesfandabadi1, A. Chen2, L. Machado2, J. Carpenter2, M. Bunker3, T. Uemura2, and A. V. Kirichenko1; 1Allegheny Health Network Cancer Institute, Department of Radiation Oncology, Pittsburgh, PA, 2Allegheny Health Network Division of Transplant Surgery, Pittsburgh, PA, 3Allegheny Health Network Division of Pathology, Pittsburgh, PA
Purpose/Objective(s): This study evaluates the outcomes of liver stereotactic body radiation therapy (SBRT) with and without Liver Transplant for hepatocellular carcinoma (HCC) in patients with Child-Pugh (CP) B/C cirrhosis.
Materials/Methods: We analyzed outcomes in patients with advanced cirrhosis who underwent SBRT for HCC, either as a stand-alone treatment or as a preparatory step for liver transplant. In our institution, SBRT was the first choice for bridging or downsizing therapy of HCC prior to liver transplant. Liver SPECT with 99mTc-sulfur colloid was co-registered to treatment planning computed tomography (CT) for the guided avoidance of functionally active liver volumes (FLV) during SBRT. Outcomes assessed included local control, toxicity, and survival, with at least 6 months of radiographic follow-up. For patients undergoing transplant after SBRT, pre- and post-transplant outcomes were evaluated. Model of End-Stage Liver Disease-Sodium (MELD-Na) was used to score hepatic function before and after SBRT completion.
Results: With a median follow-up of 32 months, 45 patients (58 lesions) with HCC and CP-B/C cirrhosis received SBRT to a median dose of 45 Gy (3-5 fractions). FLV loss (34%, P < .001) was observed in all patients, and the functional and anatomic liver volumes matched well in a control group of noncirrhotic/non-HCC patients. Despite marked functional parenchyma retraction, the amount of FLV on SPECT exposed to the threshold irradiation was significantly less than the CT liver volumes (P < .001) because of the optimized beam placement during dosimetry planning. Twenty-three patients (51%) successfully completed orthotopic liver transplant, with a median time to transplant of 9.2 months. With 91% in-field local control, the overall 2-year survival was 65% (90% after the orthotopic liver transplant), with no incidence of radiation-induced liver disease observed within 3 to 4 months or accelerate CP class migration from B to C within the first 6 months post-SBRT. Mean MELD-Na score was not significantly elevated at 3-month intervals after SBRT completion.
Conclusion: Liver SBRT with functional treatment planning appears to be safe and effective treatment for HCC in patients with CP-B/C cirrhosis, leading to low toxicity and satisfactory liver transplant outcomes.