AUTHOR=Walter Franziska , Fuchs Frederik , Gerum Sabine , Rottler Maya C. , Erdelkamp Robert , Neumann Jens , Nierer Lukas , Guba Markus , De Toni Enrico N. , Seidensticker Max , Ricke Jens , Belka Claus , Corradini Stefanie 

TITLE=HDR Brachytherapy and SBRT as Bridging Therapy to Liver Transplantation in HCC Patients: A Single-Center Experience

JOURNAL=Frontiers in Oncology

VOLUME=Volume 11 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2021.717792

DOI=10.3389/fonc.2021.717792

ISSN=2234-943X

ABSTRACT=Background
In the treatment of patients with HCC awaiting liver transplantation (LT), local ablative treatments (LAT) are available either for downstaging or as bridging treatment. We present our clinical experience with both available radiation-based techniques, brachytherapy (BT) and stereotactic body radiotherapy (SBRT).
Methods
All patients diagnosed with HCC, who were treated with BT or SBRT at our institution between 2011 and 2018 were retrospectively reviewed. The current analysis included all patients who subsequently underwent LT. 
Results
A total of 14 patients (male=9; female=5) were evaluated, 7 underwent BT for bridging before LT and 7 were treated with SBRT. BT was performed with a prescribed dose of 1x15Gy, while SBRT was applied with 37.Gy (65%-iso) in three fractions in 6 patients, and one patient was treated with 54Gy (100%-iso) in 9 fractions. The treatment was generally well tolerated, one case of grade 3 bleeding was reported after BT, and one case of liver failure occurred following SBRT. All patients underwent LT after a median time interval of 152 days (range 47-311) after BT and 202 days (range 44-775) following SBRT. In 8 cases, no viable tumor was found in the explanted liver, while 4 liver specimens showed vital tumor. The median follow-up after SBRT was 41month and 17 month following BT. Overall, no hepatic HCC recurrence occurred following LT.
Conclusion
Both SBRT and BT are feasible and well tolerated as bridging to LT when applied with caution in patients with impaired liver function. Radiation based treatments can close the gap for patients not suitable for other locally ablative treatment options.