Stereotactic body radiation therapy combined with transcatheter arterial embolization as a downstaging treatment to transplant for hepatocellular carcinoma with portal vein tumor thrombus

Abstract Background: Liver transplantation (LT) is an effective treatment for hepatocellular carcinoma (HCC). However, as portal vein tumor thrombus (PVTT) is often viewed as a relative contraindication, patients with this condition frequently miss the opportunity for LT. This study aimed to explore stereotactic body radiation therapy (SBRT) combined with transcatheter arterial embolization therapy (TAE) to control PVTT, downstage it to LT, and increase survival. Methods: Between September 2016 and June 2022, 17 patients with HCC-PVTT were treated with SBRT combined with TAE and underwent LT after a successful downgrade. All patients were followedup and evaluated regularly. The Kaplan-Meier test was used for the analysis of survival. Results: Of the study population, post-LT,the 12-, 18-, 24-, 36- and 60-month overall survival (OS) rateswere 100%, 88.24%, 64.71%, 47.06%, and 17.65%, respectively. Post-LT, the 12-, 18-, 24-, 36- and 60-month progression-free survival rates were 82.35%, 64.71%, 47.06%, 29.41%, and 17.65%, respectively. The median OS was 37 months. Conclusions: SBRT combined with TAE as a downstaging therapy, followed by LT,showed a satisfactory effect in patients with HCC-PVTT. However, it is necessary to increase the sample size and perform a long-term follow-up.