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Cureus. 2018 Oct 26;10(10):e3499. doi: 10.7759/cureus.3499.

Orthotopic Liver Transplantation After Stereotactic Body Radiotherapy for Pediatric Hepatocellular Carcinoma with Central Biliary Obstruction and Nodal Involvement.

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Radiation Oncology, Stanford University School of Medicine, Stanford, USA.
Pediatric Hematology / Oncology, Lucile Packard Children's Hospital, Stanford, USA.
Surgery, Stanford University School of Medicine, Stanford, USA.
Surgery, Lucile Packard Children's Hospital, Stanford, USA.
Interventional Radiology, Stanford University School of Medicine, Stanford, USA.
Radiation Oncology, Stanford University Medical Center, Stanford, USA.


Here we describe the case of a 10-year-old boy with a history of chronic hepatitis B who was diagnosed with hepatocellular carcinoma (HCC) with a large central hepatic mass and metastatic disease in a celiac lymph node. His tumor was unresectable, due to location and lack of clear margins, and he could not receive chemotherapy due to elevated bilirubin. He was treated with stereotactic body radiotherapy (SBRT) to the primary site and involved nodal region. After completing radiotherapy, his total bilirubin level fell below 1.0 mg/dL, allowing him to begin systemic therapy with cisplatin and doxorubicin. At three months after SBRT, his bilirubin was 0.1 mg/dL, alpha-fetoprotein (AFP) was 88 ng/mL, and imaging demonstrated a decrease in tumor size (total volume 28.7 cc), with no evidence of local or distant disease progression. He then developed distant disease within the liver, but his disease remained controlled at the primary site and nodes that had been treated with SBRT. He underwent orthotopic liver transplantation (OLT) with an uneventful operative course and remains with no evidence of disease at seven months after OLT. This is one of the first reported cases of successful downstaging of pediatric HCC with nodal involvement to allow for OLT, and it argues for consideration of similar patients for OLT.


downstaging; hepatocellular carcinomas (hcc); pediatric oncology; sbrt; transplant

Conflict of interest statement

The authors have declared that no competing interests exist.

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