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. 2022 Jul;33(7):775-785.e2.
doi: 10.1016/j.jvir.2022.03.021. Epub 2022 Mar 26.

Radiation Segmentectomy for the Treatment of Solitary Hepatocellular Carcinoma: Outcomes Compared with Those of Surgical Resection

Cynthia De la Garza-Ramos  1 , S Ali Montazeri  1 , Kristopher P Croome  2 , Jordan D LeGout  3 , David M Sella  3 , Sean Cleary  4 , Justin Burns  2 , Amit K Mathur  5 , Cameron J Overfield  1 , Gregory T Frey  1 , Andrew R Lewis  1 , Ricardo Paz-Fumagalli  1 , Charles A Ritchie  1 , J Mark McKinney  1 , Kabir Mody  6 , Tushar Patel  2 , Zlatko Devcic  1 , Beau B Toskich  7
Affiliations

Radiation Segmentectomy for the Treatment of Solitary Hepatocellular Carcinoma: Outcomes Compared with Those of Surgical Resection

Cynthia De la Garza-Ramos et al. J Vasc Interv Radiol. 2022 Jul.

Abstract

Purpose: To investigate the outcomes of radiation segmentectomy (RS) versus standard-of-care surgical resection (SR).

Materials and methods: A multisite, retrospective analysis of treatment-naïve patients who underwent either RS or SR was performed. The inclusion criteria were solitary hepatocellular carcinoma ≤8 cm in size, Eastern Cooperative Oncology Cohort performance status of 0-1, and absence of macrovascular invasion or extrahepatic disease. Target tumor and overall progression, time to progression (TTP), and overall survival rates were assessed. Outcomes were censored for liver transplantation.

Results: A total of 123 patients were included (RS, 57; SR, 66). Tumor size, Child-Pugh class, albumin-bilirubin score, platelet count, and fibrosis stage were significantly different between cohorts (P ≤ .01). Major adverse events (AEs), defined as grade ≥3 per the Clavien-Dindo classification, occurred in 0 patients in the RS cohort vs 13 (20%) patients in the SR cohort (P < .001). Target tumor progression occurred in 3 (5%) patients who underwent RS and 5 (8%) patients who underwent SR. Overall progression occurred in 19 (33%) patients who underwent RS and 21 (32%) patients who underwent SR. The median overall TTP was 21.9 and 29.4 months after RS and SR, respectively (95% confidence interval [CI], 15.5-28.2 and 18.5-40.3, respectively; P = .03). Overall TTP subgroup analyses showed no difference between treatment cohorts with fibrosis stages 3-4 (P = .26) and a platelet count of <150 × 109/L (P = .29). The overall progression hazard ratio for RS versus SR was not significant per the multivariate Cox regression analysis (1.16; 95% CI, 0.51-2.63; P = .71). The median overall survival was not reached for either of the cohorts. Propensity scores were calculated but were too dissimilar for analysis.

Conclusions: RS and SR were performed in different patient populations, which limits comparison. RS approached SR outcomes, with a lower incidence of major AEs, in patients who were not eligible for hepatectomy.

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