Stereotactic Body Radiation Therapy for Intrahepatic Graft Recurrences of Hepatocellular Carcinoma After Liver Transplantation: A Report of Two Cases.

The management of intrahepatic recurrences after orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC) is challenging. Graft hepatectomy may not be feasible, and systemic therapy (ST) options are limited due to the increased risk of graft rejection with immunotherapy use. Stereotactic body radiation therapy (SBRT) is a safe and effective locoregional therapy (LRT) option for HCC, although there is a paucity of data in the post-OLT setting. Here, we present two cases of post-OLT intrahepatic HCC recurrences treated with SBRT.  Two patients who received SBRT for post-OLT intrahepatic recurrences were identified from a single academic institution with a high-volume liver transplant program. Prior to treatment, cases were reviewed at a multidisciplinary liver tumor board. Baseline and treatment characteristics, as well as clinical outcomes such as local control (LC), progression-free survival (PFS), and adverse events (AEs), were retrospectively evaluated from the date of SBRT completion to last follow-up. Linear accelerator-based liver SBRT was planned using four-dimensional computed tomography (4DCT) simulation, abdominal compression, and volumetric modulated arc therapy. Institutional planning objectives were followed to achieve PTV95%>99% and to limit liver D