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Comparative Study
. 2025 Sep 30;25(1):1449.
doi: 10.1186/s12885-025-14931-1.

Lenvatinib in combination with radiotherapy versus lenvatinib with transarterial chemoembolization for advanced hepatocellular carcinoma

Wen-Yu Chuang  1 , Po-Chien Shen  1 , Sung-Hua Chiu  2 , Wen-Yen Huang  1 , Wei-Chou Chang  2 , Chun-Shu Lin  1 , Cheng-Hsiang Lo  3
Affiliations
Comparative Study

Lenvatinib in combination with radiotherapy versus lenvatinib with transarterial chemoembolization for advanced hepatocellular carcinoma

Wen-Yu Chuang et al. BMC Cancer. .

Abstract

Background: This study aimed to evaluate the efficacy of lenvatinib combined with either radiotherapy (RT) or transarterial chemoembolization (TACE) in patients with advanced hepatocellular carcinoma (HCC).

Methods: Conducted between December 2018 and January 2022, this retrospective study included 32 patients with advanced HCC from a single institution. The patients were divided into two treatment groups: RT plus lenvatinib (n = 17) and TACE plus lenvatinib (n = 15). The primary outcomes assessed were overall survival (OS) and infield control (IFC). Treatment modalities, patient demographics, disease characteristics, and therapeutic responses were analyzed using the Kaplan-Meier method and Cox regression models to identify predictors of OS and IFC. To address baseline imbalances and competing risks, inverse-probability-of-treatment weighting (IPTW) and Fine-Gray analyses were applied to better estimate IFC outcomes.

Results: With a median follow-up of 10.2 months, no significant difference in OS was observed between the RT and TACE groups. However, the Kaplan-Meier analysis indicated significantly longer IFC durations in the RT group (p = 0.010), with a 1-year IFC rate of 74.7% compared to 13.2% in the TACE group. Multivariable analysis further demonstrated that the RT group was associated with better IFC outcomes (p = 0.023). After IPTW adjustment, the RT group retained a significant IFC benefit (p = 0.020). At 12 months, the cumulative infield failure rate was 61.0% in the TACE group versus 14.9% in the RT group (p = 0.015). Alpha-fetoprotein levels significantly declined within 3 months after RT (p = 0.002) but not after TACE (p = 0.510). A ≥ 2-point deterioration in the Child-Pugh score was observed in 5.9% of the RT group when compared to 26.7% of the TACE group (p = 0.161).

Conclusion: These findings suggest that RT combined with lenvatinib may offer advantages in local tumor control and potentially liver function preservation, providing a promising alternative for patients with advanced HCC.

Keywords: Combined modality therapy; Hepatocellular carcinoma; Lenvatinib; Radiotherapy; Transarterial chemoembolization.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study adhered to the guidelines of the Declaration of Helsinki and was approved by the Institutional Review Board of Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan ((TSGHIRB No.: B202405172). Patient consent was waived because the data were analyzed in an anonymized format. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Kaplan-Meier curves of OS for patients in the RT and TACE groups
Fig. 2
Fig. 2
Kaplan-Meier curves of IFC A and multivariable cox regression of IFC B for patients in the RT and TACE groups
Fig. 3
Fig. 3
Changes in serum AFP levels at baseline and within 3 months after local therapy (referred to as “3-mon post-LT” in the figure) in the RT and TACE groups. Box plots display the median, interquartile range (IQR), and full range (whiskers), with outliers shown as open circles. AFP levels are presented on a logarithmic scale. A significant decline in AFP level was observed in the RT group (p = 0.002), whereas no significant change occurred in the TACE group (p = 0.510), suggesting a differential AFP response between treatment modalities. AFP levels are plotted with a logarithmic Y-axis. Please note that due to chart editor scaling and rendering based on original values, the visual positions of Q1 and Q3 may appear compressed or slightly inconsistent with tabulated IQR values
See this image and copyright information in PMC

References

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