Garg Rashi, Foley Kimberly, Movahedi Babak, Masciocchi Mark J, Bledsoe Jacob R, Ding Linda, Rava Paul, Fitzgerald Thomas J, Sioshansi Shirin
Department of Radiation Oncology, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts.
Department of Transplant Surgery, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts.
Adv Radiat Oncol. 2020 Sep 14;6(1):100559. doi: 10.1016/j.adro.2020.08.016. eCollection 2021 Jan-Feb.
For patients with hepatocellular carcinoma awaiting liver transplantation (LT), stereotactic body radiation therapy (SBRT) has emerged as a bridging treatment to ensure patients maintain priority status and eligibility per Milan criteria. In this study, we aimed to determine the efficacy and safety of SBRT in such situations.
A retrospective analysis was conducted of the outcomes of 27 patients treated with SBRT who were listed for LT at 1 institution. Among these, 20 patients with 26 tumors went on to LT and were the focus of this study. Operative reports and postoperative charts were evaluated for potential radiation-related complications. The explant pathology findings were correlated with equivalent dose in 2 Gy fractions and tumor size.
Median pretreatment tumor size was 3.05 cm. Median total dose of radiation was 50 Gy delivered in 5 fractions. Pathologic complete response (pCR) was achieved in 16 tumors (62%). Median interval from end of SBRT to transplant was 287 days. Of the 21 tumors imaged before transplant, 16 or 76% demonstrated a clinical complete response based on modified Response Evaluation Criteria in Solid Tumors criteria. There was no significant correlation between pCR rate and increasing tumor size (odds ratio [OR], 0.95; 95% confidence interval, 0.595-1.53) or pCR rate and equivalent dose in 2 Gy fractions (OR, 1.03; 95% confidence interval, 0.984-1.07.) No patients experienced radiation-related operative or postoperative complications. Of the 27 patients who were listed for transplant, the dropout rate was 22%. Two of the 5 patients with Child-Pugh score 10 died of liver failure.
These data demonstrate that SBRT as a bridging modality is a feasible option, with a pCR rate comparable to that of other bridging modalities and no additional radiation-related operative or postoperative complications. There was no dose dependence nor size dependence for pCR rate, which may indicate that for the tumor sizes in this study, the radiation doses delivered were sufficiently high.
对于等待肝移植（LT）的肝细胞癌患者，立体定向体部放疗（SBRT）已成为一种过渡性治疗方法，以确保患者保持米兰标准规定的优先地位和资格。在本研究中，我们旨在确定SBRT在这种情况下的疗效和安全性。
对1家机构中27例接受SBRT治疗并列入LT名单的患者的结局进行回顾性分析。其中，20例患有26个肿瘤的患者继续接受LT治疗，他们是本研究的重点。对手术报告和术后图表进行评估，以查找潜在的辐射相关并发症。将切除标本的病理结果与2 Gy分割剂量的等效剂量和肿瘤大小进行关联分析。
预处理前肿瘤大小的中位数为3.05 cm。放疗总剂量中位数为50 Gy，分5次给予。16个肿瘤（62%）实现了病理完全缓解（pCR）。从SBRT结束到移植的中位间隔时间为287天。在移植前成像的21个肿瘤中，根据实体瘤改良疗效评价标准，16个（76%）显示临床完全缓解。pCR率与肿瘤大小增加（优势比[OR]，0.95；95%置信区间，0.595 - 1.53）或pCR率与2 Gy分割剂量的等效剂量（OR，1.03；95%置信区间，0.984 - 1.07）之间无显著相关性。没有患者出现辐射相关的手术或术后并发症。在列入移植名单的27例患者中，退出率为22%。5例Child-Pugh评分为10分的患者中有2例死于肝衰竭。
这些数据表明，SBRT作为一种过渡方式是一种可行的选择，其pCR率与其他过渡方式相当，且无额外的辐射相关手术或术后并发症。pCR率不存在剂量依赖性和大小依赖性，这可能表明对于本研究中的肿瘤大小，所给予的辐射剂量足够高。
