Effect of radiotherapy on survival in advanced hepatocellular carcinoma patients treated with sorafenib: a nationwide cancer-registry-based study

Abstract

Sorafenib is the standard treatment for advanced hepatocellular carcinoma (HCC) patients. This study aims to determine whether combining radiotherapy with sorafenib administration increases its efficacy. The study cohort included 4763 patients with diagnosed advanced HCC who received sorafenib between January 2012 and December 2015, as reported in medical records in the Taiwan Cancer Registry database. The effect of sorafenib with or without radiotherapy on survival was calculated using the Kaplan–Meier method and compared using the log-rank test. A Cox proportional hazards model was used for multivariate analysis. Patients receiving sorafenib plus radiotherapy had greater 1-year survival than did those receiving sorafenib alone (P < 0.001). Uni- and multivariate analyses also showed that radiotherapy increased survival after adjusting for confounders (adjusted HR 0.57; 95% CI 0.51–0.63). Further stratified analysis according to the timing of radiotherapy relative to sorafenib treatment revealed that patients who underwent radiotherapy after sorafenib had greater 1-year survival than did those undergoing radiotherapy within sorafenib use or sorafenib alone (adjusted HR 0.39; 95% CI 0.27–0.54). Combined treatment with sorafenib and radiotherapy results in greater HCC patient survival and should be considered an option for treating this challenging disease.

Strategies to improve sorafenib efficacy during image-guided treatment of hepatocellular carcinoma

“…Ricke et al evaluated the potential impact of the combination of sorafenib and selective yttrium-90 transarterial radioembolization and showed that combination treatment did not improve OS of the patients compared to sorafenib only therapy (112). However, a retrospective study that included 4,763 patients diagnosed with HCC showed improved OS of the patients that underwent radiotherapy within sorafenib use compared to patients that only received sorafenib therapy (113). Moreover, a recent clinical trial demonstrated that a combination of sorafenib, hepatic arterial infusion chemotherapy of oxaliplatin, fluorouracil, and leucovorin, and FOLFOX enhances OS of advancedstage HCC patients compared to individuals who received sorafenib monotherapy (114).…”

FTH promotes the proliferation and renders the HCC cells specifically resist to ferroptosis by maintaining iron homeostasis

“…Liver cancer, one of the most common neoplastic malignancies, is characterized by high incidence, postsurgical recurrence and poor prognosis [ 1 , 2 ]. Hepatocellular carcinoma (HCC) accounts for 70–90% of primary liver cancer, caused a heavy burden of disease on people and is estimated to be the third leading cause of cancer-related death worldwide [ 2 ].…”

Role of radiotherapy in Barcelona Clinic Liver Cancer stage C hepatocellular carcinoma treated with sorafenib

“…13,14 However, these drugs are limited to only patients with preserved liver function and their response rates are unsatisfactory. 15,16 In clinical practice, patients who progress after sorafenib frequently receive local treatments, including TACE and RT, 17 but evidences of their efficacy are lacking.…”