Table 1 Patient characteristics.
Patient No | Aetiology of cirrhosis, Child Pugh grade/ score | Maximum diameter of HCC lesion | Previous treatment | SABR radiation dose & fractions | Post SABR imaging report (months post SABR) | Time from SABR to transplant | AFP pre and post SABR | Time from post-SABR imaging to transplant | Explant histology report |
|---|---|---|---|---|---|---|---|---|---|
1 | PBC, CPA (6) | 2.8 cm | Percutaneous ethanol injections (HCC located next to TIPSS stent) | 50 Gy in 5 fractions | MRI liver (3 months) – no conclusive evidence of active HCC, subtle enhancement around previously treated tumour, possibly post radiotherapy change. MRI liver (11 months) – no significant arterialised abnormality. | 12 months | 1668 to 3 | 1 month | One viable hyperplastic nodule (treated lesion measuring 0.7x1cm), and a second well-differentiated HCC 1 cm maximum diameter (not previously seen on imaging). |
2 | ARLD CP A(6) | 3.5 cm | TACE x 2 Sep and Oct 2019 | 50 Gy in 5 fractions | CT liver (3 months) – mild uniform enhancement within treated nodule, reduced in size to 2 cm, no evidence of tumour activity. | 6 months | AFP 5 to 8 | 4 months | 4 cm area of scarring with a central nodule 1.6 cm in diameter, moderately differentiated HCC with peri-tumoural vascular invasion. |
3 | MASLD CP A(5) | 4.5 cm | TACE Nov 2019 | 40 Gy in 5 fractions | CT liver (2 months) – hyper-enhancing mass slightly well-defined but increased in size to 5 cm, 1.7 cm arterialised satellite nodule, geographic hyperenhancement in surrounding parenchyma potentially reflects SABR but makes delineation of lesion more challenging. | 3 months | AFP 3 to 4 | 1 month | Single tumour 4.6 cm moderately differentiated HCC. The vast majority of the tumour is viable, with several foci suspicious for vascular invasion. |
4 | MASLD CP A(6) | 3 lesions largest 3.5 cm | TACE Jan 2018 | 50 Gy in 5 fractions | MRI liver (3 months) no convincing active disease, mixed density lesion demonstrates increased T1 signal and no convincing washout, likely to represent post-treatment haemorrhage. CT (5 months)– no convincing residual active disease, further two indeterminate arterialised abnormalities. CT (8 months)– appearances stable, unchanged from previous. | 9 months | AFP 5 to 3 | 1 month | Four discrete tumours largest 3 cm, all macroscopically similar, in keeping with viable well-differentiated HCC, foci of vascular invasion identified. |
5 | MASLD CP A(6) | 2.7 cm | TACE Jan 2022 | 50 Gy in 5 fractions | No post-SABR pre-transplant imaging | 1 month | 3 (no post-SABR result) | n/a | 2 ×2.5 cm moderately differentiated HCC viable with no evidence of necrosis. |
6 | ARLD and MASLD CP A(5) | 2.7 cm | TACE March 2022 | 45 Gy in 5 fractions | CT (2 months) – focus of residual persistent arterial hyperenhancement at treated lesion, continued follow-up recommended to differentiate residual disease from post-treatment change. | 4 months | 242 to 107 | 2 months | 1.6 cm moderately differentiated HCC, no vascular invasion. |
