Publication

Abstract :

Background: Patients with HCC and PVTT have a poor prognosis and are not offered liver transplant.

Aim: To report survival outcome of living related donor liver transplant for patients with HCC with PVTT (portal vein tumor thrombus) treated with Stereotactic hypo fractionated radiotherapy (SHORT), and TACE.

Material & Methods: Patients with liver confined HCC with PVTT and minimum 1000 cc volume of uninvolved cirrhotic liver underwent SHORT and TACE, former administered using Rapid Arc, dose 32-50Gy in 5-14 fractions. TACE was performed using gel foam slurry, Inj. Cisplatinum and PVA. Liver transplant was performed on radiological evidence of recanalization or conversion to bland thrombus, liver and venous system confined HCC and good general condition.

Results: Nineteen patients underwent SHORT, 15 with TACE. Liver transplant could be performed in 7 (37%) patients, and treatment escalated with hepatectomy or reirradiation in 2 (10%) patients, each. Five patients were lost to follow up after progressive disease. The survival of patients undergoing transplant was 100% at 12 months, and 86% at 18 and 24 months. Following transplant, 3 patients died of progressive disease at 13, 26 and 36 months, respectively. One patient is alive with disease, three disease free at 27, 28 and 31 months since registration.

Conclusion: SHORT and TACE, may allow liver transplant in select patients with HCC & PVTT resulting in excellent 24 month survival, long-term outcome remaining unclear,though.