Uemura Tadahiro, Kirichenko Alexander, Bunker Mark, Vincent Molly, Machado Lorenzo, Thai Ngoc
Department of Surgery, Abdominal Transplantation and Hepato-Biliary Surgery, Allegheny General Hospital, Pittsburgh, PA, 15212, USA.
Radiation Oncology, Allegheny General Hospital, Pittsburgh, USA.
World J Surg. 2019 Mar;43(3):886-893. doi: 10.1007/s00268-018-4829-x.
Trans-arterial chemoembolization and radiofrequency ablation are commonly used for control of hepatocellular carcinoma (HCC) on liver transplant (LTx) waiting list. Stereotactic body radiation therapy (SBRT) was introduced to our institution for HCC as a bridging or downsizing therapy to LTx.
Twenty-five HCC lesions in 22 patients were treated with SBRT while waiting for LTx from January 2010 to December 2015. Nineteen of these patients received deceased donor LTx. SBRT was defined as 40-50 Gy delivered in 4-6 fractions. Pre- and post-liver transplant outcome were analyzed in addition to the dropout rate and tumor response to SBRT.
Median size of original tumors was 3.2 cm (2.0-8.9), and median size of tumor after SBRT was significantly smaller at 0.9 cm (0-3.2) in the explanted livers (p < 0.01). The dropout rate was 9%, and they were only downsized patients outside of Milan criteria. Liver disease did not progress between pre- and post-SBRT except one patient. Twenty-eight percent of treated HCCs showed complete pathologic response, and 22% had extensive partial response with some residual tumor. No HCC recurrence was experienced after LTx.
SBRT is indicated to be safe, effective treatment for HCC on LTx waiting list, and it leads to satisfactory post-liver transplant outcomes.
经动脉化疗栓塞术和射频消融术常用于控制肝移植（LTx）等待名单上的肝细胞癌（HCC）。立体定向体部放射治疗（SBRT）作为一种向肝移植的桥接或降期治疗方法被引入我们机构用于治疗肝癌。
2010年1月至2015年12月期间，22例患者的25个肝癌病灶在等待肝移植期间接受了SBRT治疗。其中19例患者接受了尸体供肝肝移植。SBRT定义为分4 - 6次给予40 - 50Gy剂量。除了分析肝移植前后的结果外，还分析了退出率和肿瘤对SBRT的反应。
原发病灶的中位大小为3.2cm（2.0 - 8.9cm），在切除的肝脏中，SBRT治疗后肿瘤的中位大小显著减小至0.9cm（0 - 3.2cm）（p < 0.01）。退出率为9%，且他们只是不符合米兰标准的降期患者。除1例患者外，SBRT治疗前后肝病均未进展。28%接受治疗的肝癌显示完全病理缓解，22%有广泛部分缓解且有一些残留肿瘤。肝移植后未发生肝癌复发。
SBRT被证明是肝移植等待名单上肝癌的一种安全、有效的治疗方法，并且能带来令人满意的肝移植后结果。
