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Transarterial Radioembolization Versus Concurrent Chemoradiation Therapy for Locally Advanced Hepatocellular Carcinoma: A Propensity Score Matching Analysis

 Jeong Eun Song  ;  Kyu Sik Jung  ;  Do Young Kim  ;  Kijun Song  ;  Jong Yun Won  ;  Hye Won Lee  ;  Beom Kyung Kim  ;  Seung Up Kim  ;  Jun Yong Park  ;  Sang Hoon Ahn  ;  Jinsil Seong  ;  Kwang-Hyub Han 
 International Journal of Radiation Oncology Biology Physics, Vol.99(2) : 396-406, 2017 
Journal Title
 International Journal of Radiation Oncology Biology Physics 
Issue Date
Adult ; Age Factors ; Aged ; Aged, 80 and over ; Antimetabolites, Antineoplastic/administration & dosage ; Carcinoma, Hepatocellular/mortality ; Carcinoma, Hepatocellular/pathology ; Carcinoma, Hepatocellular/therapy* ; Chemoembolization, Therapeutic/adverse effects ; Chemoembolization, Therapeutic/methods* ; Chemoembolization, Therapeutic/mortality ; Chemoradiotherapy/adverse effects ; Chemoradiotherapy/methods* ; Chemoradiotherapy/mortality ; Disease-Free Survival ; Female ; Fluorouracil/administration & dosage ; Humans ; Liver Neoplasms/mortality ; Liver Neoplasms/pathology ; Liver Neoplasms/therapy* ; Male ; Middle Aged ; Portal Vein ; Propensity Score ; Retrospective Studies ; Time Factors ; Treatment Outcome ; Tumor Burden ; Venous Thrombosis ; Yttrium Radioisotopes/therapeutic use
PURPOSE: It is unclear whether the efficacy and safety of concurrent chemoradiation therapy (CCRT) and transarterial radioembolization (TARE) with 90Y are comparable in patients with locally advanced hepatocellular carcinoma. METHODS AND MATERIALS: In total, 209 treatment-naive patients with stage B or C cancer according to the Barcelona Clinic Liver Cancer classification who were treated with TARE or CCRT were analyzed. Propensity scores were calculated and matched at a 1:1 ratio for TARE versus CCRT using age, tumor size, tumor number, portal vein thrombosis, and Barcelona Clinic Liver Cancer staging. In the CCRT group, concurrent hepatic arterial infusion chemotherapy with 5-fluorouracil was delivered at a dosage of 500 mg/d during the first and last 5 days of radiation therapy (median, 45 Gy). Overall survival, freedom from progression, tumor response, and complication rate were compared between the TARE and CCRT groups. RESULTS: Among 209 patients, 124 (62 undergoing TARE and 62 undergoing CCRT) were selected after propensity score matching. Overall survival (TARE vs CCRT, 14.0 months vs 13.2 months, P=.435) and freedom from progression (6.9 months vs 7.8 months, P=.437) were comparable between the 2 groups. Objective response rates at 1 month after treatment were higher for CCRT than for TARE (46.8% vs 16.1%, P<.001), while objective response rates at 3 months were significantly higher for TARE than for CCRT (39.3% vs 21.4%, P=.04). There was no significant difference in long-term response rates (at 6 months and 1 year) between the 2 groups. The CCRT group experienced a higher rate of curative resection or liver transplantation after treatment than the TARE group, although the statistical significance was marginal (24.2% vs 11.3%, P=.060). Treatment-related complications were less frequent after TARE than after CCRT. CONCLUSIONS: Both treatments yielded comparable survival rates and long-term response rates in patients with intermediate- or advanced-stage hepatocellular carcinoma. The role of these modalities as a bridge to curative therapy requires further investigation.
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1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실)
Yonsei Authors
김도영(Kim, Do Young)
김범경(Kim, Beom Kyung) ORCID logo https://orcid.org/0000-0002-5363-2496
김승업(Kim, Seung Up) ORCID logo https://orcid.org/0000-0002-9658-8050
박준용(Park, Jun Yong) ORCID logo https://orcid.org/0000-0001-6324-2224
성진실(Seong, Jin Sil) ORCID logo https://orcid.org/0000-0003-1794-5951
안상훈(Ahn, Sang Hoon) ORCID logo https://orcid.org/0000-0002-3629-4624
원종윤(Won, Jong Yun)
이혜원(Lee, Hye Won) ORCID logo https://orcid.org/0000-0002-3552-3560
정규식(Jung, Kyu Sik)
한광협(Han, Kwang-Hyub) ORCID logo https://orcid.org/0000-0003-3960-6539
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