Safety and Efficacy of Hypofractionated Radiotherapy Combined with Tyrosine Kinase Inhibitors in Patients with Lung Metastases after Liver Transplantation for Hepatocellular Carcinoma.

We evaluated the safety and efficacy of hypofractionated radiotherapy (HFRT) combined with tyrosine kinase inhibitors (TKIs) in patients with pulmonary metastases after orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC). Twenty-five patients with lung metastases after OLT for HCC who underwent HFRT using helical tomotherapy concomitantly with TKIs (sorafenib or lenvatinib) were retrospectively. The primary endpoint was progression-free survival (PFS). The secondary endpoints were overall survival (OS), local control rate (LCR), objective response rate (ORR), and treatment-related side effects. The median follow-up time was 35.5 months, with a median interval from OLT to lung metastasis of 15.3 months. The median PFS and OS were 9.9 and 32.7 months, respectively. The 1-, 2-, and 3-year PFS and OS rates were 36.0%, 16.0%, and 12.0%, and 84.0%, 52.0%, and 20.0%, respectively. The LCR of pulmonary metastases at 1 year was 100%, whereas the two-year LCR was 76.9%. The 1- and 2- year ORRs were 95.2% and 69.2%, respectively, with no grade > 2 adverse events. Radiation pneumonitis was observed in 17 patients (68.0%). Grade 1 pneumonitis occurred in 15 patients (60.0%), and grade 2 pneumonitis occurred in 2 patients (8.0%). The combination therapy of HFRT with TKIs is a feasible, safe, and promising approach in the treatment of pulmonary metastases for HCC after OLT. [ABSTRACT FROM AUTHOR]