title: Stereotactic body radiation therapy in hepatocellular carcinoma and cirrhosis: evaluation of radiological and pathological response.
abstract: BACKGROUND
  Loco-regional therapies for cirrhotic patients with hepatocellular carcinoma (HCC) who are awaiting liver transplantation (OLT) attempt to prevent tumor progression. However, there is limited data regarding the efficacy of stereotactic body radiation therapy (SBRT) as loco-regional treatment.
  
  
  METHODS
  From 2006 to 2009, 27 HCC patients (AJCC I, II) listed for OLT underwent SBRT. Thirty-nine lesions were treated and 27 assessed radiologically. Seventeen patients had OLT, liver explants were analyzed and 22 lesions underwent pathological evaluation.
  
  
  RESULTS
  In a cumulative analysis of all imaging, 30% had complete response, 7% had partial response, 56% were stable, and 7% had progression of disease. Of the 22 pathologically evaluated lesions, 37% were responders: 14% with complete response, 23% with partial response, and 63% with no response. Side effects from SBRT were recorded in three patients, which included nausea in two and liver decompensation in one.
  
  
  CONCLUSIONS
  SBRT achieves total or partial radiological response in 37% of patients and total or partial pathological response in 37% of patients with early HCC in the setting of cirrhosis. SBRT may be a safe and effective alternative for local tumor control in patients with HCC and cirrhosis awaiting OLT.
authors.affiliation: Recanati Miller Transplant Institute, Mount Sinai Medical Center, Mount Sinai School of Medicine, New York, New York, USA. marcelo.facciuto@mountsinai.org
authors.forename: Marcelo E
authors.initials: ME
authors.lastname: Facciuto
authors.forename: Manoj K
authors.initials: MK
authors.lastname: Singh
authors.forename: Caroline
authors.initials: C
authors.lastname: Rochon
authors.forename: Jyoti
authors.initials: J
authors.lastname: Sharma
authors.forename: Cecilia
authors.initials: C
authors.lastname: Gimenez
authors.forename: Umadevi
authors.initials: U
authors.lastname: Katta
authors.forename: Chitti R
authors.initials: CR
authors.lastname: Moorthy
authors.forename: Stuart
authors.initials: S
authors.lastname: Bentley-Hibbert
authors.forename: Manuel
authors.initials: M
authors.lastname: Rodriguez-Davalos
authors.forename: David C
authors.initials: DC
authors.lastname: Wolf
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016461:Chemoembolization, Therapeutic; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016634:Radiosurgery