title: Stereotactic hypofractionated radiation therapy as a bridge to transplantation for hepatocellular carcinoma: clinical outcome and pathologic correlation.
abstract: OBJECTIVE
  We sought to determine efficacy, safety, and outcome of stereotactic hypofractionated radiation therapy (SHORT) as a suitable bridging therapy for patients awaiting liver transplantation (LT) for hepatocellular carcinoma (HCC). We also examined histological response to radiation in the resected or explanted livers.
  
  
  METHODS
  Between August 2007 and January 2009, 18 patients with 21 lesions received SHORT. A median total dose of 50 Gy was delivered in 10 fractions. Three patients underwent either chemoembolization (n = 1) or radiofrequency ablation (n = 2) prior to SHORT. Radiographic response was based on computed tomography evaluation at 3 months after SHORT. Histological response as a percentage of tumor necrosis was assessed by a quantitative morphometric method.
  
  
  RESULTS
  Six of 18 patients were delisted because of progression (n = 3) or other causes (n = 3). Twelve patients successfully underwent major hepatic resection (n = 1) or LT (n = 11) at a median follow-up of 6.3 months (range, 0.6-11.6 months) after completion of SHORT. No patient developed gastrointestinal toxicity Grade ≥3 or radiation-induced liver disease. Ten patients with 11 lesions were evaluable for pathological response. Two lesions had 100% necrosis, three lesions had ≥50% necrosis, four lesions had ≤50% necrosis, and two lesions had no necrosis. All patients were alive after LT and/or major hepatic resection at a median follow-up of 19.6 months.
  
  
  CONCLUSIONS
  SHORT is an effective bridging therapy for patients awaiting LT for HCC. It provides excellent in-field control with minimal side effects, helps to downsize or stabilize tumors prior to LT, and achieves good pathological response.
authors.affiliation: Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY 14642, USA. alan_katz@urmc.rochester.edu
authors.forename: Alan W
authors.initials: AW
authors.lastname: Katz
authors.forename: Sheema
authors.initials: S
authors.lastname: Chawla
authors.forename: Zhenhong
authors.initials: Z
authors.lastname: Qu
authors.forename: Randeep
authors.initials: R
authors.lastname: Kashyap
authors.forename: Michael T
authors.initials: MT
authors.lastname: Milano
authors.forename: Aram F
authors.initials: AF
authors.lastname: Hezel
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008099:Liver / Q000033:anatomy & histology / Q000528:radiation effects; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D009929:Organ Size; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D047368:Tumor Burden; D014850:Waiting Lists