Stereotactic body radiation effective bridging therapy for HCC patients before liver transplant

Radiation therapy comes with a price paid, Stereotactic body radiation therapy (SBRT), is a cancer treatment that is extremely precise, to cancer cells while minimizing damage to healthy tissue however, lack of data on its safety and efficacy makes it questionable. SBRT is typically used to treat small, early-stage lung cancer and pancreatic cancer, or cancers that have spread to the lung, liver, adrenal gland, or spine.

A Prospective study by Tiffany Cho-Lam Wong and team has revealed that Stereotactic body radiation therapy (SBRT) was safe, with a remarkably high control rate of hepatocellular carcinoma. It also reduced the risk of liver transplant waitlist dropout, and can be used as an alternative to conventional bridging therapies.

The findings of the study are published in Hepatology journal.

The objective of the study was to evaluate the efficacy and safety of SBRT as bridging therapy, with comparison with transarterial chemoembolization (TACE) and high-intensity focused ultrasound (HIFU).

The study prospective study that enrolled for SBRT under a standardized protocol from July 2015. Study compared with a retrospective cohort of patients who underwent TACE or HIFU from 2010. The primary endpoint was tumor control rate at 1 year after bridging therapy. Secondary endpoints included cumulative incidence of dropout, toxicity, and posttransplant survival.

The results of the study were

• A total of 150 patients were evaluated (SBRT, n = 40; TACE, n = 59; HIFU, n = 51). The tumor control rate at 1 year was significantly higher after SBRT compared with TACE and HIFU with 92.3%, 43.5%, and 33.3%; P = 0.02).

• Competing risk analysis, showed the cumulative incidence of dropout at 1 and 3 years after listing was lower after SBRT (15.1% and 23.3%) compared with TACE (28.9% and 45.8%; P = 0.034) and HIFU (33.3% and 45.1%; P = 0.032).

• Time-to-progression at 1 and 3 years was also superior after SBRT (10.8%, 18.5% in SBRT, 45%, 54.9% in TACE, and 47.6%, 62.8% in HIFU; P < 0.001).

• The periprocedural toxicity was similar, without any difference in perioperative complications and patient and recurrence-free survival rates after transplant.

• Pathological complete response was more frequent after SBRT compared with TACE and HIFU (48.1% vs. 25% vs. 17.9%, respectively; P = 0.037).

• In multivariable analysis, tumor size <3 cm, listing alpha-fetoprotein <200 ng/mL, Child A, and SBRT significantly reduced the risk of dropout.

Wong and team concluded that "SBRT was safe, with a significantly higher tumor control rate, reduced the risk of waitlist dropout, and should be used as an alternative to conventional bridging therapies."

Reference : https://doi.org/10.1002/hep.31992