External-beam radiation underused in people with liver cancer awaiting transplant

Reuters Health - 05/11/2021 - External-beam radiation therapy (EBRT) is a safe and effective non-invasive bridging therapy for patients awaiting liver transplant yet it is highly underused for this purpose in the United States, according to a new study.

Hepatocellular carcinoma (HCC) is a leading cause of cancer worldwide, with incidence increasing in the U.S.

"For patients with localized HCC and advanced cirrhosis, liver transplantation is their best chance for long-term survival," Dr. Nima Nabavizadeh of Oregon Health & Science University, in Portland, said at a press briefing at the American Society for Radiation Oncology annual meeting.

As patients often wait months to over a year for a transplant, many receive liver-directed bridging therapies to prevent tumor growth or spread and to remain eligible for transplant, he explained.

These bridging therapies may include thermal ablation procedures, transarterial chemoembolization (TACE), radiofrequency ablation (RFA), Y-90 radioembolization and ERBT.

To see which bridging therapies are used most often in patients waitlisted for liver transplant, Dr. Nabavizadeh and his colleagues did a retrospective analysis of United Network for Organ Sharing (UNOS) data from 2013 to 2020.

Among a total of more than 18,000 HCC patients, 85.4% received some type of bridging therapy while awaiting transplant, but only 3.6% received EBRT, either alone (1.2%) or in combination with another therapy (2.4%).

Most patients received chemoembolization (39.6%). Thermal ablation was used for 12.8% of patients and Y-90 radioembolization for 8.7%. Nearly a quarter of patients (22.2%) received a combination of non-ERBT therapies.

From the period of 2014 to 2019, use of transarterial chemoembolization decreased and was largely replaced by thermal ablation or Y-90 radioembolization.

During this timeframe, the average annual percent change for EBRT was 11.4% compared with 23.4% for Y-90 radioembolization.

There was no statistical difference between patients who received ERBT versus patients who did not receive ERBT in terms of age, initial MELD score, initial bilirubin, history of portal vein thrombosis, baseline alpha-fetoprotein, tumor diameter or total number of tumors.

ERBT use varied significantly by geographic region, from a high of 8.7% in the Great Lakes states (Michigan, Ohio and Indiana) to a low of 1.7% in the Southeast (Florida, Georgia, Mississippi, Alabama, Louisiana and Arkansas).

This study shows that EBRT as a bridging therapy to liver transplant is "underutilized" compared to other liver-directed therapies, Dr. Nabavizadeh told the briefing.

"As an established safe, effective and non-invasive bridging therapy, low national utilization of ERBT, and in turn stereotactic body radiation therapy (SBRT), highlights a real-world gap in the treatment armamentarium for HCC and an opportunity to improve care of HCC patients in need of liver transplant," he concluded.

The study had no commercial funding and the authors have no relevant disclosures.

SOURCE: https://bit.ly/2ZvRpxR American Society for Radiation Oncology annual meeting, presented October 25, 2021.

By Megan Brooks



Posted on 5 November 20219 November 2021