The management of patients with hepatocellular carcinoma and cirrhosis awaiting liver transplant is a dilemma due to organ shortage and long wait times. We report the acute toxicity and evaluate the explant pathology in patients receiving stereotactic body radiation therapy (SBRT) as a bridge to liver transplantation. From November 2005 to June 2007, 5 patients with six hepatomas were treated with SBRT as a bridge to liver transplantation. The median tumor size was 3.2 cm (range, 2.9-5.5 cm). The median radiation dose was 48 Gy (range, 33-54 Gy) given in three consecutive daily fractions with a median dose of 16 Gy each (range, 11-18 Gy). The median prescription isodose line was 62% (range, 50-66%). Toxicity was graded according to the Common Terminology Criteria for Adverse Events v3.0. The mean time on the liver transplant wait list was 394 days and the mean time from SBRT to transplant was 67 days (range, 8-185 days). Mean post-transplant follow-up was 112 days (3.7 months). Following SBRT only 1 patient had acute toxicity, Grade 1 abdominal discomfort. Overall, 4 of 5 (80%) patients had no acute toxicity following SBRT. Following SBRT and liver transplantation, examination of the explant pathology revealed two of six tumors had no evidence of viable tumor for a complete respose rate of 33%. Three of six tumors decreased in size following SBRT for a partial response rate of 50%. Only one tumor increased in size, from 3.3 cm to 3.7 cm in 48 days from SBRT to transplant. Overall local control was achieved in five of six (83%) hepatomas and in these patients the median time from SBRT to transplant was 90 days. All patients are alive and there are no post-transplant hepatoma recurrences. Stereotactic body radiation therapy as a bridge to liver transplant in patients with hepatoma is safe and well tolerated. Staining to evaluate molecular damage may be helpful in assessing response to therapy in patients with short interval between treatment and transplant. As a treatment alone or as part of multimodality approach, SBRT offers promise as a bridge during the long wait to liver transplant in patients with hepatocelluar carcinoma.

DURING the past five years a general and intensive study of Juvenile Delinquency and its causes has been carried on in all parts of the country. This study has not been confined to any one phase of the subject of delinquency, nor has it been carried on by any one group of people or interests, it has been very general. It was undertaken with a sincere desire to learn the real causes and, if possible, some of the cures for delin-