Single center experience using stereotactic body radiation therapy (SBRT) on orthotopic liver transplant protocol for unresectable cholangiocarcinoma

Trudy C Wu; Jie Deng; Fang-I Chu; Saeed Sadeghi; Richard Finn; Vatche G Agopian; Percy Lee; Ann C Raldow

doi:10.1016/j.hpb.2023.12.004

Single center experience using stereotactic body radiation therapy (SBRT) on orthotopic liver transplant protocol for unresectable cholangiocarcinoma

HPB (Oxford). 2024 Mar;26(3):444-450. doi: 10.1016/j.hpb.2023.12.004. Epub 2023 Dec 10.

Authors

Trudy C Wu¹, Jie Deng², Fang-I Chu², Saeed Sadeghi³, Richard Finn³, Vatche G Agopian⁴, Percy Lee⁵, Ann C Raldow²

Affiliations

¹ Department of Radiation Oncology, University of California, Los Angeles, 200 Medical Plaza Driveway, Suite B265, Los Angeles, CA, 90095, USA. Electronic address: tcwu@mednet.ucla.edu.
² Department of Radiation Oncology, University of California, Los Angeles, 200 Medical Plaza Driveway, Suite B265, Los Angeles, CA, 90095, USA.
³ Department of Medical Oncology, University of California, Los Angeles, 200 Medical Plaza Driveway, Suite 120B, Los Angeles, CA, 90095, USA.
⁴ Department of Liver Transplant Surgery, University of California, Los Angeles, 924 Westwood Blvd, Los Angeles, CA, 90024, USA.
⁵ Department of Radiation Oncology, City of Hope Orange County, Lennar Foundation Cancer Center, 1000 Fivepoint, Irvine, CA, 92618, USA.

PMID: 38142182
DOI: 10.1016/j.hpb.2023.12.004

Abstract

Purpose: To evaluate tolerability, pathologic response, and disease outcomes utilizing pre-operative stereotactic body radiation therapy (SBRT) followed by consolidation chemotherapy (CHT) prior to orthotopic liver transplant (OLT) in unresectable cholangiocarcinoma (CCA).

Methods: This was a retrospective chart review of patients treated on OLT protocol at a single tertiary center from 2012 to 2019. Patients received pre-operative SBRT (40-50 Gy in 5 fractions) followed by CHT until progression or OLT. Progression-free survival (PFS) and overall survival (OS) were compared via log-rank test and Cox proportional hazards regression.

Results: 26 patients (84.6% hilar, 15.4% intrahepatic) were identified for analysis. Eight patients (30.8%) patients developed acute toxicity after SBRT, mostly grade 1 nausea. Nine (34.6%) patients underwent OLT of which 4 (44.4%) achieved a pathologic complete response (pCR). Five (55.6%) OLT patients, including 2 pCR, developed recurrence at a median time of 49.9 weeks after OLT. 3-year OS for the OLT and dropout cohort was 75% and 9%, respectively (p < 0.0001). OS in hilar tumors only was statistically different for those that achieved a pCR (p = 0.014).

Conclusions: Pre-operative SBRT is a well-tolerated and effective radiation technique as part of OLT protocol for unresectable CCA and conferred in a pCR rate of 44% within our cohort.

Published by Elsevier Ltd.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Bile Duct Neoplasms* / radiotherapy
Bile Duct Neoplasms* / surgery
Bile Ducts, Intrahepatic / pathology
Cholangiocarcinoma* / radiotherapy
Cholangiocarcinoma* / surgery
Humans
Liver Transplantation* / adverse effects
Radiosurgery* / adverse effects
Radiosurgery* / methods
Retrospective Studies
Treatment Outcome