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Comparative Study
. 2016 Feb 10;34(5):452-9.
doi: 10.1200/JCO.2015.61.4925. Epub 2015 Nov 30.

Outcomes After Stereotactic Body Radiotherapy or Radiofrequency Ablation for Hepatocellular Carcinoma

Daniel R Wahl  1 , Matthew H Stenmark  1 , Yebin Tao  1 , Erqi L Pollom  1 , Elaine M Caoili  1 , Theodore S Lawrence  1 , Matthew J Schipper  1 , Mary Feng  2
Affiliations
Comparative Study

Outcomes After Stereotactic Body Radiotherapy or Radiofrequency Ablation for Hepatocellular Carcinoma

Daniel R Wahl et al. J Clin Oncol. .

Abstract

Purpose: Data guiding selection of nonsurgical treatment of hepatocellular carcinoma (HCC) are lacking. We therefore compared outcomes between stereotactic body radiotherapy (SBRT) and radiofrequency ablation (RFA) for HCC.

Patients and methods: From 2004 to 2012, 224 patients with inoperable, nonmetastatic HCC underwent RFA (n = 161) to 249 tumors or image-guided SBRT (n = 63) to 83 tumors. We applied inverse probability of treatment weighting to adjust for imbalances in treatment assignment. Freedom from local progression (FFLP) and toxicity were retrospectively analyzed.

Results: RFA and SBRT groups were similar with respect to number of lesions treated per patient, type of underlying liver disease, and tumor size (median, 1.8 v 2.2 cm in maximum diameter; P = .14). However, the SBRT group had lower pretreatment Child-Pugh scores (P = .003), higher pretreatment alpha-fetoprotein levels (P = .04), and a greater number of prior liver-directed treatments (P < .001). One- and 2-year FFLP for tumors treated with RFA were 83.6% and 80.2% v 97.4% and 83.8% for SBRT. Increasing tumor size predicted for FFLP in patients treated with RFA (hazard ratio [HR], 1.54 per cm; P = .006), but not with SBRT (HR, 1.21 per cm; P = .617). For tumors ≥ 2 cm, there was decreased FFLP for RFA compared with SBRT (HR, 3.35; P = .025). Acute grade 3+ complications occurred after 11% and 5% of RFA and SBRT treatments, respectively (P = .31). Overall survival 1 and 2 years after treatment was 70% and 53% after RFA and 74% and 46% after SBRT.

Conclusion: Both RFA and SBRT are effective local treatment options for inoperable HCC. Although these data are retrospective, SBRT appears to be a reasonable first-line treatment of inoperable, larger HCC.

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Conflict of interest statement

Authors’ disclosures of potential conflicts of interest are found in the article online at www.jco.org. Author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
Freedom from local progression (FFLP) by treatment modality. RFA, radiofrequency ablation; SBRT, stereotactic body radiotherapy.
Fig 2.
Fig 2.
Freedom from local progression (FFLP) by treatment modality by tumor size. Solid line represents hazard ratio estimate, and dashed lines represent 95% CIs. y-axis is plotted on a logarithmic scale (base = 5). RFA, radiofrequency ablation; SBRT, stereotactic body radiotherapy.
Fig 3.
Fig 3.
(A) Freedom from local progression (FFLP) for tumors smaller than 2 cm by treatment modality. (B) FFLP for tumors ≥ 2 cm by treatment modality. RFA, radiofrequency ablation; SBRT, stereotactic body radiotherapy.
See this image and copyright information in PMC

Comment in

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