{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T14:02:29Z","timestamp":1758636149569,"version":"3.33.0"},"reference-count":11,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","license":[{"start":{"date-parts":[[2013,10,1]],"date-time":"2013-10-01T00:00:00Z","timestamp":1380585600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2013,9,24]],"date-time":"2013-09-24T00:00:00Z","timestamp":1379980800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2013,10]]},"abstract":"<jats:sec>\n            <jats:title\/>\n            <jats:p>Despite the widespread use of locoregional therapies [radiofrequency ablation and transarterial chemoembolization (TACE)], there is currently a lack of high-quality evidence supporting their use for hepatocellular carcinoma (HCC) in patients on the liver transplantation (LT) waiting list or requiring down-staging. Radiotherapy has rarely been used in this setting and has usually been in the form of more complex and less accessible techniques such as proton-beam and stereotactic body radiation therapy. Only 1 report describes the use of conventional 3-dimensional conformal external-beam radiotherapy (cEBRT) techniques as neoadjuvant or down-staging therapy for patients who are LT candidates. This report describes the use of cEBRT in a 52-year-old hepatitis C\u2013positive man with cirrhosis. A 40-mm right lobe HCC was treated initially with TACE while he was on the waiting list. The lesion progressed beyond transplant criteria (76 mm). Conventional external-beam radiotherapy (EBRT) was used (54 Gy in 27 fractions) to down-stage the lesion. EBRT was well tolerated and resulted in a complete radiological response with no arterial enhancement of the lesion for a total of 16 months. Subsequent LT and a review of the explant demonstrated complete histological necrosis of the lesion. This report provides the first description of complete histological necrosis of HCC through the use of cEBRT techniques as down-staging\/neoadjuvant therapy before LT. Because of its potential efficacy, accessibility, tolerability, noninvasive and outpatient nature, and ability to treat lesions adjacent to vessels and biliary structures, further trials examining the efficacy of cEBRT versus other neoadjuvant techniques are urgently required. <jats:italic toggle=\"yes\">Liver Transpl 19:1119\u20131124, 2013<\/jats:italic>. \u00a9 2013 AASLD.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1002\/lt.23714","type":"journal-article","created":{"date-parts":[[2013,7,25]],"date-time":"2013-07-25T22:08:35Z","timestamp":1374790115000},"page":"1119-1124","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":8,"title":["Down-staging of hepatocellular carcinoma via external-beam radiotherapy with subsequent liver transplantation: A case report"],"prefix":"10.1097","volume":"19","author":[{"given":"Alan","family":"Wigg","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth","family":"Hon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leigh","family":"Mosel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"Sladden","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin","family":"Palumbo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"R1-9-20250124","doi-asserted-by":"crossref","first-page":"665673","DOI":"10.1002\/lt.20636","article-title":"Lack of benefit of pretransplant locoregional hepatic therapy for hepatocellular cancer in the current MELD era.","volume":"12","author":"Porrett","year":"2006","journal-title":"Liver Transpl"},{"key":"R2-9-20250124","doi-asserted-by":"crossref","first-page":"664671","DOI":"10.1111\/j.1440-1746.2009.06126.x","article-title":"Radiotherapy for hepatocellular carcinoma: systematic review of radiobiology and modeling projections indicate reconsideration of its use.","volume":"25","author":"Wigg","year":"2010","journal-title":"J Gastroenterol Hepatol"},{"key":"R3-9-20250124","doi-asserted-by":"crossref","first-page":"810821","DOI":"10.1016\/S0360-3016(02)02846-8","article-title":"Analysis of radiationinduced liver disease using the Lyman NTCP model.","volume":"53","author":"Dawson","year":"2002","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"R4-9-20250124","doi-asserted-by":"crossref","first-page":"150155","DOI":"10.1016\/S0360-3016(02)02864-X","article-title":"Doseresponse relationship in local radiotherapy for hepatocellular carcinoma.","volume":"54","author":"Park","year":"2002","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"R5-9-20250124","doi-asserted-by":"crossref","first-page":"15021509","DOI":"10.1016\/j.ijrobp.2004.05.048","article-title":"Biologic susceptibility of hepatocellular carcinoma patients treated with radiotherapy to radiationinduced liver disease.","volume":"60","author":"Cheng","year":"2004","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"R6-9-20250124","doi-asserted-by":"crossref","first-page":"16531663","DOI":"10.1002\/cncr.21811","article-title":"Radiation therapy for hepatocellular carcinoma: from palliation to cure.","volume":"106","author":"Hawkins","year":"2006","journal-title":"Cancer"},{"key":"R7-9-20250124","doi-asserted-by":"crossref","first-page":"11521158","DOI":"10.1016\/j.ijrobp.2006.06.015","article-title":"Feasibility and efficacy of highdose threedimensionalconformal radiotherapy in cirrhotic patients with smallsize hepatocellular carcinoma noneligible for curative therapiesmature results of the French phase II RTF1 trial.","volume":"66","author":"Mornex","year":"2006","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"R8-9-20250124","doi-asserted-by":"crossref","first-page":"30533059","DOI":"10.1002\/cncr.25809","article-title":"The safety and efficacy of highdose proton beam radiotherapy for hepatocellular carcinoma: a phase 2 prospective trial.","volume":"117","author":"Bush","year":"2011","journal-title":"Cancer"},{"key":"R9-9-20250124","first-page":"949954","article-title":"Longterm outcomes of stereotactic body radiation therapy in the treatment of hepatocellular cancer as a bridge to transplantation.","volume":"18","author":"OConnor","year":"2012","journal-title":"Liver Transpl"},{"key":"R10-9-20250124","doi-asserted-by":"crossref","first-page":"299306","DOI":"10.1111\/j.1432-2277.2009.00980.x","article-title":"Radiotherapy as a bridge to liver transplantation for hepatocellular carcinoma.","volume":"23","author":"Sandroussi","year":"2010","journal-title":"Transpl Int"},{"key":"R11-9-20250124","doi-asserted-by":"crossref","first-page":"113119","DOI":"10.1016\/S0360-3016(03)00434-6","article-title":"Prospective trial of combined transcatheter arterial chemoembolization and threedimensional conformal radiotherapy for portal vein tumor thrombus in patients with unresectable hepatocellular carcinoma.","volume":"57","author":"Yamada","year":"2003","journal-title":"Int J Radiat Oncol Biol Phys"}],"container-title":["Liver 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