Mini-Oral Presentation

Stereotactic body radiotherapy as neoadjuvant treatment in liver transplantation for klatskin tumor

Presenter

Aliaksei Shcherba (BY)

Chief of visceral, HPB and Transplant Clinic · Visceral, HPB and LT · Minsk medical center for surgery transplantation and hematology · Minsk

Profile

Authors

Aliksei Shcherba¹, Elena Zvereva², Leanid Kirkovsksky¹, Andrei Sauchenko¹, Aliaksei Fedaruk¹, Oleg Kozak¹, Alexander Dziadzko³, Oleg Rummo¹

Affiliations

¹ Minsk medical center for surgery, transplantation and hematology

² Minsk medical center for surgery, transplantation and hematology

³ Minsk medical center for surgery, transplantation and hematology

Abstract

Background: Liver transplantation is an established kind of treatment for unresectable, borderline and suspicious of R1 proximal margin perihilar cholangiocarcinoma. Neoadjuvant chemoradiation is a mandatory tool for achieving better oncological result according to Mayo Clinic and similar protocols. Substitution of SBRT for brachytherapy may be an alternative radiation regimen because of significant heterogeneity of doses delivered by brachytherapy and due to accuracy of high ablative doses per SBRT-fraction when brachytherapy is not feasible.
Methods: 18 Patients with MRI, MDCT and PET-18FDG signatures of unresectable, borderline-resectable with prognostication of R1 margin, longitudinal extension only above d. cysticus, N0M0 perihilar cholangiocarcinoma with tumor mass < 3 cm were included since 2017.
Exclusion - failure to complete SBRT and progression.
Biopsy was obtained in 3 patients with accessible tumor mass.
Exploration was administered electively if indicated by PET.
Metabolically active lesions:
perichilar - were included into SBRT targeted area despite the possibility of being N1,
parenchymal - managed by repeated PET due to possibility of being inflammatory cholongitis-driven.
SBRT : 45 Gy in 3 doses.
No neoadjuvant chemotherapy.
No touch policy: 90 days after SBTR followed by restaging by MDCT, CA-19-9, repeated PET.
Results: PET-18-FDG staging implemented in 11/14 patients and 10/14 completed SBRT.
Time to transplant since diagnosis 4 -12 months.
Fibrosis + PSC on explant pathology in 4/14 pts (28%)
3/14 pts had progression after LT (21%) including 2/10 pts (20%) after SBRT.
Overall mortality is 28% (4/14), cancer related mortality 21% (3/14) including 1/10 after SBRT.
Follow-up : 5 months -9 years.
Conclusions: SBRT has potential advantages including greater generalizability, minimal invasiveness, and greater simplicity compared to intraluminal brachytherapy. Strict adherence to current standards of diagnostic, staging and decision as well as common sense in liver transplantation for tumors can provide the best possible result. More data needed whether SBRT alone can substitute chemo-radiation.