Efficacy and Safety of SBRT as a Bridge to Liver Transplant for Unresectable

Hepatocellular Carcinoma
A recent phase 2 nonrandomized controlled trial investigated the use of stereotactic body radiotherapy (SBRT) as a bridging therapy to deceased donor liver transplant (DDLT) for patients with previously untreated, unresectable hepatocellular carcinoma (HCC). This study aimed to evaluate the efficacy and safety of SBRT in this context.

Study Design and Participants: The trial included 32 eligible patients within the University of California, San Francisco (UCSF) criteria. These patients underwent dual-tracer positron emission tomography with computed tomography (PET-CT) and magnetic resonance imaging (MRI) with gadoxetate before receiving SBRT of 35 to 50 Gy in 5 fractions. The same imaging techniques were used to monitor patients while they awaited DDLT .

Main Findings:

• Progression-Free Survival (PFS) and Overall Survival (OS):Median PFS was 17.6 months, with a 5-year PFS of 39.9%.
• Median OS was 60.5 months, with a 5-year OS of 51.3% .
• Objective Response Rates (ORRs):ORRs were 62.5% by RECIST 1.1, 71.9% by mRECIST, and 78.1% by PERCIST in terms of patients.
• ORRs were 75.0% by RECIST 1.1, 83.9% by mRECIST, and 87.5% by PERCIST in terms of lesions .
• Pathologic Complete Response:Of the 20 patients who received DDLT, 15 (75.0%) exhibited pathologic complete response in the liver explants .

Safety and Toxicity: Toxic effects associated with SBRT were reported in 9 patients (28.1%), with only one grade 3 event. This indicates that SBRT was generally well-tolerated .

Conclusion: This study demonstrated promising survival outcomes and acceptable safety profiles for SBRT as a bridging therapy before DDLT for unresectable HCC. The results support the consideration of SBRT as an effective and safe option under the surveillance of contemporary imaging modalities.

Implications for Practice: Future randomized clinical trials are warranted to confirm these findings and to further optimize the use of SBRT in bridging therapy for HCC patients awaiting liver transplantation.

For more details, refer to the original study: JAMA Network Open. 2024;7(6)