Dynamic tumor-tracking stereotactic body radiation therapy for a solitary tumor in a transplanted organ: two case report
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CASE REPORT
Dynamic tumor‑tracking stereotactic body radiation therapy for a solitary tumor in a transplanted organ: two case reports Shun Okabayashi1 · Yukinori Matsuo1 · Noriko Kishi1 · Hideki Hanazawa1 · Takashi Mizowaki1 Received: 1 April 2020 / Accepted: 24 June 2020 © The Japan Society of Clinical Oncology 2020
Abstract Solid-organ transplant recipients require long-term immunosuppressants to prevent graft rejection. However, immunosuppressant use increases the risk of malignancy. Radiotherapy can be a treatment option for patients who are medically inoperable or refuse surgery; however, whether the irradiation of transplanted organs is safe remains unclear. We present two patients with malignancies that developed in transplanted organs and were treated with dynamic tumor-tracking (DTT) stereotactic body radiation therapy (SBRT). The first patient underwent transplantation owing to liver cirrhosis caused by hepatitis C virus and subsequently developed hepatocellular carcinoma in the donated liver. There was no evidence of recurrence 12 months post-treatment, and liver function enzyme levels did not deviate from their pre-SBRT baselines. The second patient had a solitary tongue cancer metastasis in a transplanted lung; she also had a history of interstitial pneumonia caused by scleroderma. Six weeks after DTT-SBRT, she developed grade 3 radiation pneumonitis but recovered with oral steroids; she experienced no tumor recurrence after 14 months, although her respiratory function was worse than it was pre-SBRT owing to post-transplant rejection. DTT-SBRT is thus feasible for treating tumors that arise in transplanted lungs and livers. Keywords Stereotactic body radiation therapy · Dynamic tumor tracking · Lung tumor · Liver tumor · Solid-organ transplant · Radiotherapy
Introduction The development of malignancy is one of the most disruptive complications in organ transplant recipients. Immunosuppressants, required by the solid-organ transplant recipients for the prevention of graft rejection, increase the risk of malignancy and infection [1, 2]. The incidence rate of cancer depends on the type of transplanted organ and is generally two- to fourfold higher in transplant patients [1, 3]. The risk in these patients also increases with time, and is 7–10% and 16–24% at 5 and 10 years post-transplantation, respectively [3–5]. Malignancy is the cause of death for 29% of heart transplant recipients who survive more than 5 years [6]. Radiotherapy can be an effective treatment option for patients with cancer, but whether the irradiation of transplanted organs is safe remains unclear. Herein, we present * Yukinori Matsuo [email protected]‑u.ac.jp 1
Department of Radiation Oncology and Image‑Applied Therapy, Kyoto University Graduate School of Medicine, 54 Shogoin‑Kawaharacho, Sakyo‑ku, Kyoto 606‑8507, Japan
two patients who were treated with dynamic tumor-tracking (DTT) stereotactic body radiation therapy (SBRT) for solitary tumors in transplanted organs; one had a recurrent hepatocellular carcinoma (HCC) in her
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