Few patients with hepatocellular carcinoma (HCC) who are wait-listed for liver transplantation receive bridging therapy with external-beam radiation therapy (EBRT), according to a study presented at the annual meeting of the American Society for Radiation Oncology, held from Oct. 24 to 27 in Chicago.
Nima Nabavizadeh, M.D., from the Oregon Health & Science University in Portland, and colleagues examined the national prevalence of EBRT among patients with HCC waitlisted for liver transplantation in the United States in a retrospective analysis of the United Network for Organ Sharing dataset from October 2013 to June 2020. A total of 18,447 HCC patients were identified who had applied for Model of End-Stage Liver Disease exceptions to receive wait-list prioritization.
The researchers found that 60.6 percent of patients received a liver transplant at a median seven months from exception application. Overall, 85.4 percent of patients received any bridging liver-directed therapy (LDT). Six hundred fifty-eight patients (3.6 percent of the overall cohort) received EBRT alone or combined with other bridging LDTs. Among all patients, EBRT use increased over time, with a 14 percent average annual increase. There was significant variation observed in use of EBRT by geographic region, with the highest and lowest use seen in the Great Lakes states (Michigan, Ohio, and Indiana) and the Southeast (Florida, Georgia, Mississippi, Alabama, Louisiana, and Arkansas; 8.7 and 1.7 percent, respectively).
“External-beam radiation therapy is a proven, established, safe, and effective treatment option for patients with unresectable liver cancer, yet its under-utilization within this population — fewer than 4 percent of patients — highlights a real-world gap in treatment options available for patients with hepatocellular carcinoma,” Nabavizadeh said in a statement.
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