Au Kin Pan, Chiang Chi Leung, Chan Albert Chi Yan, Cheung Tan To, Lo Chung Mau, Chok Kenneth Siu Ho
Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong 999077, China.
Department of Clinical Oncology, Queen Mary Hospital, the University of Hong Kong, Hong Kong 999077, China.
World J Clin Cases. 2020 Jul 6;8(13):2758-2768. doi: 10.12998/wjcc.v8.i13.2758.
Graft hepatocellular carcinoma (HCC) recurrence after liver transplant is more frequently encountered. Graft hepatectomy is technically challenging and is associated with high morbidity. Stereotactic body radiation therapy (SBRT) has been shown to be safe and effective for the treatment of primary HCC. However, its role in HCC recurrence in a liver graft remains unclear.
To evaluate the safety and efficacy of SBRT for the treatment of graft HCC recurrence after liver transplantation.
A retrospective study was conducted. From 2012 to 2018, 6 patients with intrahepatic HCC recurrence after liver transplant were treated with SBRT at Queen Mary Hospital, the University of Hong Kong. The primary outcome was time to overall disease progression and secondary outcomes were time to local progression and best local response, as assessed with the Modified response Evaluation Criteria for Solid Tumours criteria. Patients were monitored for treatment related toxicities and graft dysfunction.
A total of 9 treatment courses were given for 13 tumours. The median tumour size was 2.3 cm (range 0.7-3.6 cm). Two (22%) patients had inferior vena cava tumour thrombus. The best local treatment response was: 5 (55%) complete response, 1 (11%) partial response and 3 (33%) stable disease. After a median follow up duration of 15.5 mo, no local progression or mortality was yet observed. The median time to overall disease progression was 6.5 mo. There were 6 regional progression in the liver graft (67%) and 2 distant progression in the lung (22%). There was no grade 3 or above toxicity and there was no graft dysfunction after SBRT.
SBRT appears to be safe in this context. Regional progression is the mode of failure.
肝移植术后移植肝肝细胞癌（HCC）复发较为常见。移植肝切除术在技术上具有挑战性，且并发症发生率高。立体定向体部放射治疗（SBRT）已被证明对原发性HCC的治疗是安全有效的。然而，其在移植肝HCC复发中的作用仍不明确。
评估SBRT治疗肝移植术后移植肝HCC复发的安全性和有效性。
进行一项回顾性研究。2012年至2018年，香港大学玛丽医院对6例肝移植术后肝内HCC复发患者进行了SBRT治疗。主要结局是至疾病总体进展时间，次要结局是至局部进展时间和最佳局部反应，采用实体瘤改良反应评估标准进行评估。对患者进行治疗相关毒性和移植肝功能障碍监测。
共对13个肿瘤进行了9个疗程的治疗。肿瘤中位大小为2.3 cm（范围0.7 - 3.6 cm）。2例（22%）患者有下腔静脉肿瘤血栓。最佳局部治疗反应为：5例（55%）完全缓解，1例（11%）部分缓解，3例（33%）病情稳定。中位随访时间15.5个月后，未观察到局部进展或死亡。至疾病总体进展的中位时间为6.5个月。移植肝有6例（67%）区域进展，肺有2例（22%）远处进展。SBRT后无3级或以上毒性，也无移植肝功能障碍。
在这种情况下，SBRT似乎是安全的。区域进展是失败模式。
