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Comparative Study
. 2018 Mar 15;100(4):950-958.
doi: 10.1016/j.ijrobp.2017.12.014. Epub 2017 Dec 15.

Comparison of Stereotactic Body Radiation Therapy and Radiofrequency Ablation in the Treatment of Intrahepatic Metastases

William C Jackson  1 , Yebin Tao  1 , Mishal Mendiratta-Lala  2 , Latifa Bazzi  1 , Dan R Wahl  1 , Matthew J Schipper  1 , Mary Feng  3 , Kyle C Cuneo  1 , Theodore S Lawrence  1 , Dawn Owen  4
Affiliations
Comparative Study

Comparison of Stereotactic Body Radiation Therapy and Radiofrequency Ablation in the Treatment of Intrahepatic Metastases

William C Jackson et al. Int J Radiat Oncol Biol Phys. .

Abstract

Purpose: Stereotactic body radiation therapy (SBRT) and radiofrequency ablation (RFA) are widely used therapies for the treatment of intrahepatic metastases; however, direct comparisons are lacking. We sought to compare outcomes for these 2 modalities.

Methods and materials: From 2000 to 2015, 161 patients with 282 pathologically diagnosed unresectable liver metastases were treated with RFA (n = 112) or SBRT (n = 170) at a single institution. The primary outcome was freedom from local progression (FFLP). The effect of treatment and covariates on FFLP was modeled using a mixed-effects Cox model with application of inverse probability treatment weighting to adjust for potential imbalances in treatment modality.

Results: The median follow-up period was 24.6 months. Patients receiving SBRT had larger tumors than those treated with RFA (median, 2.7 cm vs 1.8 cm; P < .01). On univariate analysis, tumor size was associated with worse FFLP for RFA (hazard ratio [HR]; 1.57; 95% confidence interval [CI], 1.15-2.14; P < .01) but not for SBRT (HR, 1.38; 95% CI, 0.76-2.51; P = .3). The 2-year FFLP rate was 88.2% compared with 73.9%, favoring SBRT (P = .06). For tumors ≥2 cm in diameter, SBRT was associated with improved FFLP (HR, 0.28; 95% CI, 0.09-0.93; P < .01). On multivariate analysis, treatment with SBRT (HR, 0.21; 95% CI, 0.07-0.62; P = .005) and smaller tumor size (HR, 0.65; 95% CI, 0.47-0.91; P = .01) were associated with improved FFLP. The 2-year overall survival rate was 51.1%, with no difference between groups (P = .8). Grade ≥3 treatment-related toxicity was rare, with no difference between SBRT (n = 4) and RFA (n = 3).

Conclusions: Treatment with SBRT or RFA is well tolerated and provides excellent and similar local control for intrahepatic metastases <2 cm in size. For tumors ≥2 cm in size, treatment with SBRT is associated with improved FFLP and may be the preferable treatment.

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Conflict of interest statement

Conflict of interest: none.

Figures

Fig. 1.
Fig. 1.
Freedom from local progression (FFLP) by treatment modality. Abbreviations: CI = confidence interval; HR = hazard ratio; RFA = radiofrequency ablation; SBRT = stereotactic body radiation therapy.
Fig. 2.
Fig. 2.
Freedom from local progression (FFLP) by treatment modality stratified by tumor size. The solid central line denotes hazard ratio estimates, with the dashed lines representing 95% confidence intervals. The x-axis is stratified by tumor-size quintiles. Abbreviations: RFA = radiofrequency ablation; SBRT = stereotactic body radiation therapy.
Fig. 3.
Fig. 3.
Overall survival (OS) by treatment modality. Abbreviations: RFA = radiofrequency ablation; SBRT = stereotactic body radiation therapy.
See this image and copyright information in PMC

Comment in

  • In Regard to Jackson et al.
    Slovak R, Lu DS, Raja J, Arellano RS, Kim HS. Slovak R, et al. Int J Radiat Oncol Biol Phys. 2019 Jul 1;104(3):695-696. doi: 10.1016/j.ijrobp.2019.03.005. Int J Radiat Oncol Biol Phys. 2019. PMID: 31162060 No abstract available.
  • In Reply to Slovak et al.
    Jackson WC, Cuneo KC, Lawrence TS, Owen D. Jackson WC, et al. Int J Radiat Oncol Biol Phys. 2019 Jul 1;104(3):696-697. doi: 10.1016/j.ijrobp.2019.03.006. Int J Radiat Oncol Biol Phys. 2019. PMID: 31162061 No abstract available.

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