Hepatic Resection Versus Stereotactic Body Radiation Therapy Plus Transhepatic Arterial Chemoembolization for Large Hepatocellular Carcinoma: A Propensity Score Analysis

Abstract

Background and Aims:There are no comparative studies on the efficacy of hepatic resection (HR) and CyberKnife stereotactic body radiation therapy (CK-SBRT) plus transhepatic arterial chemotherapy embolization (TACE) in the treatment of large hepatocellular carcinoma (HCC). Therefore, this study aimed to compare the efficacy of HR and CK-SBRT+TACE in large HCC. Methods: A total of one hundred and sixteen patients were selected from November 2011 to December 2016. Among them, 50 were allocated to the CK-SBRT+TACE group and 66 were allocated to the HR group. The Kaplan-Meier method was applied to calculate overall survival (OS) and progression-free survival (PFS) rates. Propensity score matching was performed to control for baseline differences between the groups. Results: Thirtysix paired patients were selected from the CK-SBRT+TACE and HR groups. After propensity score matching, the 1-, 2-and 3-year OS rates were 83.3%, 77.8% and 66.7% in the HR group and 80.6%, 72.2% and 52.8% in the CK-SBRT+TACE group, respectively. The 1-, 2-and 3-year PFS rates were 71.6%, 57.3% and 42.3% in the HR group and 66.1%, 45.8% and 39.3% in the CK-SBRT+TACE group, respectively (OS: p=0.143; PFS: p=0.445). Both a high platelet count and low alpha-fetoprotein value were revealed as influencing factors in improving OS and PFS. Conclusions: CK-SBRT+TACE brought local effects that were similar to those of HR in HCC patients with a large and single lesion.Moreover, the liver injury occurrence rate was acceptable in both groups.

Potential candidates for liver resection in liver-confined advanced HCC: a Chinese multicenter observational study

“…Several studies have confirmed that advanced HCC patients can benefit from liver resection ( 16 , 28 , 29 ), but these studies rarely focus on PS1 alone. In the present study, AFP, tumor size and albumin were identified as independent prognostic factors, which was consistent with previous studies and indicated high heterogeneity in such patients ( 30 – 32 ). It is necessary to further stratify HCC patients of PS1 alone according to these factors to identify appropriate candidates for liver resection.…”

Topoisomerase I Inhibition Radiosensitizing Hepatocellular Carcinoma by RNF144A-mediated DNA-PKcs Ubiquitination and Natural Killer Cell Cytotoxicity

“…With the advancement of technology, RT has become one of the treatment options for localized HCC not suitable for or refractory to conventional treatments. 3 Despite the intraarterial approach by yttrium-90 and increased dose intensity by stereotactic body RT (SBRT), radiotherapeutic effects remain unsatisfactory. 26 The inhibition of radiation-activated signaling pathways to overcome the sublethal effect may be a strategy to enhance the therapeutic effect of RT on hepatic tumors.…”

“…2 With the advancement of technology, radiotherapy (RT) has become one of the treatment choices for localized HCC tumor(s) not suitable for the conventional treatments. 3 However, enhancing the therapeutic effect of RT while protecting the surrounding healthy tissue is a great challenge to liver tumors. Hence, specific compounds targeting the inhibition of radiation-activated signaling might meet the requirement.…”

Stereotactic body radiation therapy in patients with centrally located hepatocellular carcinoma: A retrospective, single-arm, multi-center study

“…The plans enclosed PTV with 75–90% isodose line of maximum dose equated to the prescribed dose. Normal tissue tolerance doses were determined according to the AAPM TG-101 report [20] . Doses of 49 to 56 Gy in 5–7 fractions were delivered to the PTV everyday in weekdays for most patients.…”