The possibility of radiotherapy as downstaging to living donor liver transplantation for hepatocellular carcinoma with portal vein tumor thrombus

Hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) are difficult to manage with very poor survival and due to universal recurrence after liver transplantation, they have been excluded from indication. Conformer radiation therapy (RT) has been shown to be effective in the treatment of HCC but only few trials have been reported as bridge to liver transplantation (LT) in HCC with PVTT. The purpose of our study was to evaluate the possibility of applying living donor liver transplantation (LDLT) following successful downstaging using RT in advanced HCC with PVTT. Among 1360 patients who received LT at our institution between May 1996 and March 2013, 5 received RT and they were compared with a propensity score matched group of 10 patients receiving RT alone according to sex, age, tumor size and number, dose of RT, level of AFP and location of PVTT. Objective tumor response after RT was evaluated with CT and/or MRI according to modified RECIST criteria. There is no difference in clinical characteristics between both groups. Two recipients showed disease progression, but in RT alone group, all patients are shown tumor ingrowths or intra-, extra-hepatic metastasis. LDLT following RT group's OS was 1055 days and that of RT alone group's was 367 days with significant statistically difference. Conclusion: LDLT following RT can be treatment of choice for PVTT in selective patients like solitary HCC with below Vp3 PVTT and good tumor response, and we suggest that this warrants further testing in a randomized, controlled, multi-center trial. And when doing bile duct anastomosis in RT recipients, hepaticojejunostomy was recommended to prevent biliary complication. This article is protected by copyright. All rights reserved.