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SBRT as a Bridge to Liver Transplantation for Hepatocellular Carcinoma
Hepatology (Baltimore, Md.)
TAKE-HOME MESSAGE
This study evaluated the safety and efficacy of stereotactic body radiation therapy (SBRT) as a bridging therapy to liver transplantation (LT) for patients with hepatocellular carcinoma (HCC) compared with transarterial chemoembolization (TACE) and high-intensity focused ultrasound (HIFU). The primary endpoint was the tumor control rate at 1 year after bridging therapy. The results showed that the tumor control rate at 1 year was significantly higher after SBRT (92.3%) compared with TACE and HIFU (43.5% and 33.3%, respectively; P = .02). The time to progression at 1 and 3 years was also superior for SBRT (10.8% and 18.5% in SBRT; 45.0% and 54.9% in TACE; 47.6% and 62.8% in HIFU; P < .001). Pathological complete response was more frequent after SBRT (48.1%) compared with TACE (25.0%) and HIFU (17.9%; P = .037).
SBRT is safe and effective as a bridging therapy in patients with HCC on waitlist for LT and is recommended as an alternative to conventional bridging therapies.
– Natasha von Roenn, MD
abstract
This abstract is available on the publisher's site.
BACKGROUND AND AIMS
There are no prospective data on stereotactic body radiation therapy (SBRT) as a bridge to liver transplantation for HCC. This study aimed to evaluate the efficacy and safety of SBRT as bridging therapy, with comparison with transarterial chemoembolization (TACE) and high-intensity focused ultrasound (HIFU).
APPROACH AND RESULTS
Patients were prospectively enrolled for SBRT under a standardized protocol from July 2015 and compared with a retrospective cohort of patients who underwent TACE or HIFU from 2010. The primary endpoint was tumor control rate at 1 year after bridging therapy. Secondary endpoints included cumulative incidence of dropout, toxicity, and posttransplant survival. During the study period, 150 patients were evaluated (SBRT, n = 40; TACE, n = 59; HIFU, n = 51). The tumor control rate at 1 year was significantly higher after SBRT compared with TACE and HIFU (92.3%, 43.5%, and 33.3%, respectively; P = 0.02). With competing risk analysis, the cumulative incidence of dropout at 1 and 3 years after listing was lower after SBRT (15.1% and 23.3%) compared with TACE (28.9% and 45.8%; P = 0.034) and HIFU (33.3% and 45.1%; P = 0.032). Time-to-progression at 1 and 3 years was also superior after SBRT (10.8%, 18.5% in SBRT, 45%, 54.9% in TACE, and 47.6%, 62.8% in HIFU; P < 0.001). The periprocedural toxicity was similar, without any difference in perioperative complications and patient and recurrence-free survival rates after transplant. Pathological complete response was more frequent after SBRT compared with TACE and HIFU (48.1% vs. 25% vs. 17.9%, respectively; P = 0.037). In multivariable analysis, tumor size <3 cm, listing alpha-fetoprotein <200 ng/mL, Child A, and SBRT significantly reduced the risk of dropout.
CONCLUSIONS
SBRT was safe, with a significantly higher tumor control rate, reduced the risk of waitlist dropout, and should be used as an alternative to conventional bridging therapies.
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