PITTSBURGH – Liver transplantation is one of the few treatment options available that can potentially save the lives of people with liver cancer, but unfortunately many patients are not eligible for transplantation due to the invasiveness of their disease.
A study presented at the recent meeting of the American Society for Radiation Oncology (ASTRO) by doctors from Allegheny General Hospital (AGH), shows that an advanced form of radiation treatment called stereotactic body radiotherapy (SBRT) can be an effective bridge to liver transplantation for some patients with hepatocellular carcinoma (liver cancer). AGH is one of just a few leading medical centers in the world offering the novel therapy.
Commonly used to treat a variety of cancers, SBRT involves using advanced diagnostic images and computer mapping to accurately target tumors in high doses over a shorter period of time than conventional radiation therapy.
“Whereas traditional radiation requires on average over seven weeks of treatment, SBRT allows for the delivery of an even higher radiation dose over the course of four to five days with significantly better tumor control and less side effects,” said AGH radiation oncologist Alexander Kirichenko, MD, PhD.
In cases of hepatocellular carcinoma, doctors usually use a set of strict rules provided by the United Network of Organ Sharing to decide who is a candidate for successful liver transplantation. These criteria include limitations on the size, location and number of the tumors within the liver. In addition to meeting these rules, patients with liver cancer must not have any spread of the cancer outside of the liver for transplantation to be effective.
“Keeping the size and spread of liver tumors in check without damaging healthy liver tissue during bridging treatments is the key to keeping patients alive and eligible until a donor liver becomes available,” said Ngoc Thai, MD, PhD, Director of the Center for Abdominal Transplantation at AGH.
“Given the aggressiveness of this disease, however, and the average wait time for a donor liver exceeding two years, maintaining a liver cancer patient’s eligibility for transplantation can be a significant clinical challenge,” Dr. Thai said. “Our experience with SBRT to date suggests that this pioneering treatment can help us achieve that goal for some of our most critically ill patients.”
The AGH study looked at seven liver cancer patients with advanced cirrhosis who received SBRT prior to transplantation. All retained eligibility for a transplant and eventually received new livers.
“This is a very sophisticated and meticulous treatment process provided by a dedicated, multi-disciplinary team of cancer and transplantation specialists, and it is extremely gratifying to see the transformation of very sick patients facing daunting odds to healthy, thriving individuals after a successful liver transplantation,” said Dr. Kirichenko.
“We believe SBRT will ultimately become a standard bridge to liver transplant option at major transplant centers around the country,” he said.
In addition to Drs. Kirichenko and Thai, other AGH investigators who participated in the study included transplant surgeons Kusum Tom, MD and Akhtar Kahn, MD, and pathologist Jan Silverman, MD.
For more information, contact:
The West Penn Allegheny Health System