Liver transplant is the best treatment option for selected early stage hepatocellular carcinoma (HCC) patients. Given the shortage of organs with increasing time on the waitlist, it is recommended that local regional therapy be applied if the anticipated waiting time is longer than 6 months.
Local regional therapy has been widely used as a bridge to transplant, aiming to reduce tumor progression and waitlist dropout. The response to local regional therapy also predicts post-transplant recurrence and is an important tool to select biologically favorable HCC for transplant.
The ideal bridging therapy should be safe, non-invasive and effective. Various local regional therapies including transarterial chemoembolization (TACE), radiofrequency ablation (RFA), high intensity focused ultrasound (HIFU) and selective internal radiation therapy (SIRT) have been studied extensively. Recently, our team has pioneered the use of stereotactic body radiation therapy (SBRT) as bridging therapy. We have demonstrated SBRT offered better tumor control at 1-year and reduced the risk of waitlist dropout. Since then, SBRT has replaced other local regional therapy as the 1st line bridging therapy for HCC waitlist candidates.
