Janjan N A, Cohen E, Adams M, Stewart E, Foley D, Varma R
Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee.
Am J Clin Oncol. 1994 Apr;17(2):129-33. doi: 10.1097/00000421-199404000-00008.
Three patients with multifocal recurrence of hepatocellular carcinoma following liver transplantation received palliative irradiation. Hyperfractionated irradiation (150 cGy/fraction b.i.d.) was delivered in two cases to the entire liver using parallel opposed oblique portals to a total dose of 30 Gy. Conventional irradiation (180 cGy/fraction) totaling 45 Gy was administered to the liver hilus with concomitant infusional 5-fluorouracil chemotherapy in the third case. Clinicopathologic correlations were performed. At autopsy all patients had massive tumor burden within the liver. Veno-occlusive changes were observed in two patients 1 and 2 months following completion of conventional and hyperfractionated irradiation, respectively. Liver transplantation in these two patients had been performed 18 and 16 months prior to palliative hepatic irradiation. In the third patient, no veno-occlusive changes were pathologically observed at autopsy 1 month after completing hyperfractionated radiation, which was delivered 6 months following liver transplantation. No significant differences in prior immunosuppressive therapy were identified among patients. Veno-occlusive changes are not spared by hyperfractionated radiation. Transplanted livers exhibit responses to radiation similar to those normally observed.
三名肝移植后肝细胞癌多灶复发的患者接受了姑息性放疗。两例患者采用前后对穿斜野对全肝进行超分割放疗（每次150 cGy，每日两次），总剂量为30 Gy。第三例患者对肝门区进行常规放疗（每次180 cGy），总剂量45 Gy，同时给予5-氟尿嘧啶静脉滴注化疗，并进行了临床病理相关性分析。尸检发现所有患者肝脏内均有大量肿瘤负荷。分别在常规放疗和超分割放疗结束后1个月和2个月，两名患者出现了肝静脉闭塞性改变。这两名患者在姑息性肝脏放疗前18个月和16个月接受了肝移植。在第三名患者中，超分割放疗在肝移植后6个月进行，放疗结束后1个月尸检未发现肝静脉闭塞性改变。患者之间在既往免疫抑制治疗方面未发现显著差异。超分割放疗不能避免肝静脉闭塞性改变。移植肝脏对放疗的反应与正常观察到的相似。
