Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 6, 2020; 8(13): 2758-2768
Published online Jul 6, 2020. doi: 10.12998/wjcc.v8.i13.2758
Initial experience with stereotactic body radiotherapy for intrahepatic hepatocellular carcinoma recurrence after liver transplantation
Kin Pan Au, Chi Leung Chiang, Albert Chi Yan Chan, Tan To Cheung, Chung Mau Lo, Kenneth Siu Ho Chok
Kin Pan Au, Albert Chi Yan Chan, Tan To Cheung, Chung Mau Lo, Kenneth Siu Ho Chok, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong 999077, China
Chi Leung Chiang, Department of Clinical Oncology, Queen Mary Hospital, the University of Hong Kong, Hong Kong 999077, China
Author contributions: Chok KSH designed this study; Au KP and Chiang CL conducted the study, analyzed the data and wrote the manuscript; Chan ACY, Cheung TT and Lo CM reviewed and provided supervision.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster.
Informed consent statement: All patients have signed the informed consent form.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Kenneth Siu Ho Chok, FACS, FRCS (Ed), MBBS, Associate Professor, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong 999077, China. chok6275@hku.hk
Received: November 13, 2019
Peer-review started: November 13, 2019
First decision: March 15, 2020
Revised: May 14, 2020
Accepted: May 19, 2020
Article in press: May 19, 2020
Published online: July 6, 2020
Processing time: 236 Days and 14.9 Hours
Abstract
BACKGROUND

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.

AIM

To evaluate the safety and efficacy of SBRT for the treatment of graft HCC recurrence after liver transplantation.

METHODS

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.

RESULTS

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.

CONCLUSION

SBRT appears to be safe in this context. Regional progression is the mode of failure.

Keywords: Stereotactic body radiotherapy; Hepatocellular carcinoma; Liver transplantation; Recurrence; Radiosurgery; Outcomes

Core tip: From 2012 to 2018, 6 patients with intrahepatic hepatocellular carcinoma recurrence after liver transplant were treated with stereotactic body radiation therapy at Queen Mary Hospital, the University of Hong Kong. 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. Five patients had complete local response (55%). The median time to overall disease progression was 6.5 mo. There were 6 regional progression in the liver graft (67%). There was no grade 3 or above toxicity. Stereotactic body radiation therapy appears safe but regional progression is common.