Evidence map›Paper›PMID 40677697›Full record

ArticleJHEP reports : innovation in hepatology2025

SBRT for bridging and downstaging HCC before transplant.

Zhihao Li, Michael Yan, Marco P A W Claasen, Luckshi Rajendran, Christian T J Magyar, Saheli Saha, Cameron Lee, Nazia Selzner, Elmar Jaeckel, Anand Ghanekar and 19 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in JHEP reports : innovation in hepatology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Article
  2. Review
  3. Review
  4. Review
  5. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

29 authors.

Zhihao LiHBP & Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.
Michael YanRadiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
Marco P A W ClaasenHBP & Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.
Luckshi RajendranHBP & Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.
Christian T J MagyarHBP & Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.
Saheli SahaRadiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
Cameron LeeRadiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
Nazia SelznerHBP & Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.
Elmar JaeckelHBP & Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.
Anand GhanekarHBP & Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.
Mark CattralHBP & Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.
Blayne A SayedHBP & Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.
Markus SelznerHBP & Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.
Ian McGilvrayHBP & Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.
Chaya ShwaartzHBP & Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.
Trevor ReichmanHBP & Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.
Grainne M O'KaneWallace McCain Centre for Pancreatic Cancer, Princess Margaret Hospital, Toronto, ON, Canada.
Arndt VogelDivision of Gastroenterology and Hepatology, University Health Network, Toronto, ON, Canada.
Robert C GrantDivision of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
Tae Kyoung KimDepartment of Medical Imaging, University of Toronto, Toronto, ON, Canada.
Catherine Soo-Yee NaidooDepartment of Medical Imaging, University of Toronto, Toronto, ON, Canada.
Ali HosniRadiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
Rebecca WongRadiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
Aruz MesciRadiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
Jelena LukovicRadiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
Aisling BarryUniversity College Cork and Cork University Hospital, Cork, Ireland.
John KimRadiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
Laura A DawsonRadiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
Gonzalo SapisochinHBP & Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background & Aims: Stereotactic body radiotherapy (SBRT) has emerged as a bridging/downstaging therapy for patients with hepatocellular carcinoma (HCC) awaiting liver transplantation (LT). This study evaluates the safety and outcomes of the use of SBRT in such patients. Methods: A retrospective review was conducted from 2004 to 2019 on 88 adult patients with HCC receiving SBRT as bridging/downstaging therapy. Endpoints, included treatment-related toxicities, liver function decline, and LT probability post SBRT, were analyzed using competing risk analysis. Results: SBRT was used for bridging in 58 (66%) patients and downstaging in 30 (34%). Most patients had compensated liver function pre-SBRT and were treated with a median SBRT dose of 36 Gy in six fractions. Toxicities were mild (58% grade 1, 2% grade 2, and no grade 3 toxicities). Of the patients, 23% experienced a decline in liver function within 6 months post SBRT. The probability of LT post SBRT was 30% at 6 months, 61% at 1 year, and 73% at 2 years. Key predictors of LT post SBRT included model for end-stage liver disease (MELD) score, alpha-fetoprotein (AFP) level, and number and total tumor volume of HCC lesions. Overall, 61 (69%) patients underwent LT at a median of 6.3 months (IQR: 3.1-10.0) post SBRT, with major complications reported in 26% and an in-hospital mortality of 3%. Overall and recurrence-free survival at 1, 3, and 5 years post transplant were 88%, 83%, and 83% and 83%, 75%, 73%, respectively. The cumulative incidence of recurrence was significantly higher in the downstaging group compared with the bridging group (15%, 23%, and 32% Conclusions: Our results showed that SBRT is a safe and effective bridging therapy for HCC. However, its role in downstaging is limited by lower response rates and higher recurrence, emphasizing the importance of patient selection. Impact and implications: SBRT is an emerging therapy for patients with HCC awaiting LT, with limited data available on its safety and efficacy. Our study provides crucial insights for physicians and researchers, demonstrating that SBRT is a safe and effective option for bridging patients with HCC to transplantation. These findings are important for optimizing treatment strategies and providing patients with additional therapeutic options while awaiting transplantation. However, the lower response rates and higher recurrence in the downstaging group highlight the need for further research to improve patient selection and tailor treatments for optimal outcomes.

Indexed as

Bridging therapyDownstaging therapyHepatocellular carcinomaLiver transplantationStereotactic body radiotherapy

Identifiers

PMID40677697
PMCPMC12270628

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.