Multicenter Study

. 2023 Jun 14;7(7):e00184.

doi: 10.1097/HC9.0000000000000184. eCollection 2023 Jul 1.

Thermal ablation compared to stereotactic body radiation therapy for hepatocellular carcinoma: A multicenter retrospective comparative study

Andrew M Moon^{1

2}, Hannah P Kim³, Amit G Singal⁴, Dawn Owen⁵, Mishal Mendiratta-Lala⁶, Neehar D Parikh⁷, Steven C Rose⁸, Katrina A McGinty⁹, Chris B Agala¹⁰, Lauren M Burke⁹, Anjelica Abate⁶, Ersan Altun⁹, Christian Beyer¹¹, John Do⁸, Michael R Folkert¹², Chalon Forbes⁶, Jona A Hattangadi-Gluth¹³, Paul H Hayashi¹⁴, Keri Jones⁶, Gaurav Khatri¹⁵, Yuko Kono^{8

16}, Theodore S Lawrence¹⁷, Christopher Maurino¹⁷, David M Mauro⁹, Charles S Mayo¹⁷, Taemee Pak¹⁵, Preethi Patil¹⁷, Emily C Sanders¹⁸, Daniel R Simpson¹³, Joel E Tepper^{2

19}, Diwash Thapa²⁰, Ted K Yanagihara¹⁹, Kyle Wang²¹, David A Gerber^{2

10}

Affiliations

¹ Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA.
² Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA.
³ Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁴ Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
⁵ Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA.
⁶ Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.
⁷ Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
⁸ Department of Radiology, University of California-San Diego, San Diego, California, USA.
⁹ Department of Radiology, University of North Carolina, Chapel Hill, North Carolina, USA.
¹⁰ Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA.
¹¹ Division of Hospital Medicine, Baylor Scott and White Hospital System, Waxahachie, Texas, USA.
¹² Department of Radiation Medicine, Northwell Health, Lake Success, New York, USA.
¹³ Department of Radiation Oncology, University of California-San Diego, San Diego, California, USA.
¹⁴ Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA.
¹⁵ Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
¹⁶ Department of Medicine, University of California-San Diego, San Diego, California, USA.
¹⁷ Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA.
¹⁸ Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham, North Carolina, USA.
¹⁹ Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina, USA.
²⁰ University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
²¹ Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio, USA.

PMID: 37314737
PMCID: PMC10270501
DOI: 10.1097/HC9.0000000000000184

Multicenter Study

Thermal ablation compared to stereotactic body radiation therapy for hepatocellular carcinoma: A multicenter retrospective comparative study

Andrew M Moon et al. Hepatol Commun. 2023.

. 2023 Jun 14;7(7):e00184.

doi: 10.1097/HC9.0000000000000184. eCollection 2023 Jul 1.

Authors

Affiliations

¹ Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA.
² Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA.
³ Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁴ Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
⁵ Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA.
⁶ Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.
⁷ Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
⁸ Department of Radiology, University of California-San Diego, San Diego, California, USA.
⁹ Department of Radiology, University of North Carolina, Chapel Hill, North Carolina, USA.
¹⁰ Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA.
¹¹ Division of Hospital Medicine, Baylor Scott and White Hospital System, Waxahachie, Texas, USA.
¹² Department of Radiation Medicine, Northwell Health, Lake Success, New York, USA.
¹³ Department of Radiation Oncology, University of California-San Diego, San Diego, California, USA.
¹⁴ Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA.
¹⁵ Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
¹⁶ Department of Medicine, University of California-San Diego, San Diego, California, USA.
¹⁷ Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA.
¹⁸ Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham, North Carolina, USA.
¹⁹ Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina, USA.
²⁰ University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
²¹ Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio, USA.

PMID: 37314737
PMCID: PMC10270501
DOI: 10.1097/HC9.0000000000000184

Abstract

Background aims: Early-stage HCC can be treated with thermal ablation or stereotactic body radiation therapy (SBRT). We retrospectively compared local progression, mortality, and toxicity among patients with HCC treated with ablation or SBRT in a multicenter, US cohort.

Approach results: We included adult patients with treatment-naïve HCC lesions without vascular invasion treated with thermal ablation or SBRT per individual physician or institutional preference from January 2012 to December 2018. Outcomes included local progression after a 3-month landmark period assessed at the lesion level and overall survival at the patient level. Inverse probability of treatment weighting was used to account for imbalances in treatment groups. The Cox proportional hazard modeling was used to compare progression and overall survival, and logistic regression was used for toxicity. There were 642 patients with 786 lesions (median size: 2.1 cm) treated with ablation or SBRT. In adjusted analyses, SBRT was associated with a reduced risk of local progression compared to ablation (aHR 0.30, 95% CI: 0.15-0.60). However, SBRT-treated patients had an increased risk of liver dysfunction at 3 months (absolute difference 5.5%, aOR 2.31, 95% CI: 1.13-4.73) and death (aHR 2.04, 95% CI: 1.44-2.88, p < 0.0001).

Conclusions: In this multicenter study of patients with HCC, SBRT was associated with a lower risk of local progression compared to thermal ablation but higher all-cause mortality. Survival differences may be attributable to residual confounding, patient selection, or downstream treatments. These retrospective real-world data help guide treatment decisions while demonstrating the need for a prospective clinical trial.

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Conflict of interest statement

Amit G. Singal is a consultant or advisory boards for Genentech, AstraZeneca, Eisai, Bayer, Exelixis, FujiFilm Medical Sciences, Exact Sciences, Glycotest, GRAIL, Freenome, Universal Dx, and TARGET RWE. Andrew M. Moon is a consultant for TARGET RWE. David A. Gerber is a consultant for Medtronic. Dawn Owenreceived research funding (no salary support) from AstraZeneca and Varian. Honorarium from UptoDate. Michael R. Folkert received research funding (no salary support) from Boston Scientific, Inc. Neehar D. Parikh is a consultant or advisory boards for Fujifilm Medical Sciences, AstraZeneca, Eisai, Bayer, Exelixis, Exact Sciences, Freenome, and Gilead. Paul H. Hayashi: Dr. Hayashi is employed by the US Food and Drug Administration (FDA), but the opinions and conclusions in this paper do not reflect any opinions of the FDA. The FDA has not evaluated the opinions or conclusions in this paper. The remaining authors have no conflicts to report.

Figures

**FIGURE 1**
Schematic of landmark analysis used for the analysis of local progression at the lesion level.

**FIGURE 2**
Cumulative incidence (cases per month) of local progression for lesions treated with thermal ablation and stereotactic body radiation therapy. Accounts for competing risks of death and liver transplant. Time to event incorporates the 3-month landmark period. Abbreviations: MWA, microwave ablation; RFA, radiofrequency ablation; SBRT, stereotactic body radiation therapy.

**FIGURE 3**
Cumulative incidence (deaths per month) of mortality for patients treated with thermal ablation and stereotactic body radiation therapy. Accounts for competing risks of a liver transplant. Time to event incorporates the 3-month landmark period. Abbreviations: MWA, microwave ablation; RFA, radiofrequency ablation; SBRT, stereotactic body radiation therapy.

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Comment in

Reply : Understanding survival comparisons in non-randomized treatment comparisons for patients with early-stage HCC.
Moon AM, Yanagihara TK, Tepper JE, Gerber DA. Moon AM, et al. Hepatol Commun. 2023 Sep 15;7(10):e0282. doi: 10.1097/HC9.0000000000000282. eCollection 2023 Oct 1. Hepatol Commun. 2023. PMID: 37708458 Free PMC article. No abstract available.
Understanding survival comparisons in nonrandomized treatment comparisons for patients with early-stage HCC.
Khosla D, Singh G, Kapoor R. Khosla D, et al. Hepatol Commun. 2023 Dec 15;8(1):e0281. doi: 10.1097/HC9.0000000000000281. eCollection 2024 Jan 1. Hepatol Commun. 2023. PMID: 38099862 Free PMC article. No abstract available.

References

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Thermal ablation compared to stereotactic body radiation therapy for hepatocellular carcinoma: A multicenter retrospective comparative study

Affiliations

Thermal ablation compared to stereotactic body radiation therapy for hepatocellular carcinoma: A multicenter retrospective comparative study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Comment in

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical