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Stereotactic body radiation therapy vs. radiofrequency ablation in Asian patients with hepatocellular carcinoma

 Nalee Kim  ;  Jason Cheng  ;  Inkyung Jung  ;  Ja Der Liang  ;  Yu Lueng Shih  ;  Wen-Yen Huang  ;  Tomoki Kimura  ;  Victor H F Lee  ;  Zhao Chong Zeng  ;  Ren Zhenggan  ;  Chul Seung Kay  ;  Seok Jae Heo  ;  Jong Yoon Won  ;  Jinsil Seong 
 JOURNAL OF HEPATOLOGY, Vol.73(1) : 121-129, 2020-07 
Journal Title
Issue Date
Hepatocellular carcinoma ; Local control ; Prognosis ; Propensity score matching ; Radiofrequency ablation ; Stereotactic body radiation therapy
Background & aims: Few studies have been conducted to compare the efficacies of stereotactic body radiation therapy (SBRT) and radiofrequency ablation (RFA). Thus, in this multinational study, we compared the effectiveness of SBRT and RFA in patients with unresectable HCC.

Methods: The retrospective study cohort included 2,064 patients treated in 7 hospitals: 1,568 and 496 in the RFA and SBRT groups, respectively. More than half of the patients (56.5%) developed recurrent tumors, mainly after transarterial chemoembolization (44.8%). Propensity score matching was performed to adjust for clinical factors (n = 313 in each group).

Results: At baseline, the SBRT group had unfavorable clinical features compared to the RFA group, including BCLC stage (B-C 65% vs. 16%), tumor size (median 3.0 cm vs. 1.9 cm), and frequent history of liver-directed treatment (81% vs. 49%, all p <0.001). With a median follow-up of 27.7 months, the 3-year cumulative local recurrence rates in the SBRT and RFA groups were 21.2% and 27.9%, respectively (p <0.001). After adjusting for clinical factors, SBRT was related to a significantly lower risk of local recurrence than RFA in both the entire (hazard ratio [HR] 0.45, p <0.001) and matched (HR 0.36, p <0.001) cohorts. In subgroup analysis, SBRT was associated with superior local control in small tumors (≤3 cm) irrespective of location, large tumors located in the subphrenic region, and those that progressed after transarterial chemoembolization. Acute grade ≥3 toxicities occurred in 1.6% and 2.6% of the SBRT and RFA patients, respectively (p = 0.268).

Conclusions: SBRT could be an effective alternative to RFA for unresectable HCC, particularly for larger tumors (>3 cm) in a subphrenic location and tumors that have progressed after transarterial chemoembolization.

Lay summary: It is currently not known what the best treatment option is for patients with unresectable hepatocellular carcinoma. Here, we show that stereotactic body radiation therapy provides better local control than radiofrequency ablation, with comparable toxicities. Stereotactic body radiation therapy appears to be an effective alternative to radiofrequency ablation that should be considered when there is a higher risk of local recurrence or toxicity after radiofrequency ablation.
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1. College of Medicine (의과대학) > Dept. of Biomedical Systems Informatics (의생명시스템정보학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Nalee(김나리) ORCID logo https://orcid.org/0000-0003-4742-2772
Seong, Jin Sil(성진실) ORCID logo https://orcid.org/0000-0003-1794-5951
Won, Jong Yun(원종윤) ORCID logo https://orcid.org/0000-0002-8237-5628
Jung, Inkyung(정인경) ORCID logo https://orcid.org/0000-0003-3780-3213
Heo, Seok-Jae(허석재) ORCID logo https://orcid.org/0000-0002-8764-7995
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