Outcomes After Stereotactic Body Radiotherapy or Radiofrequency Ablation for Hepatocellular Carcinoma

Abstract

Data guiding selection of nonsurgical treatment of hepatocellular carcinoma (HCC) are lacking. We therefore compared outcomes between stereotactic body radiotherapy (SBRT) and radiofrequency ablation (RFA) for HCC. Patients and MethodsFrom 2004 to 2012, 224 patients with inoperable, nonmetastatic HCC underwent RFA (n = 161) to 249 tumors or image-guided SBRT (n = 63) to 83 tumors. We applied inverse probability of treatment weighting to adjust for imbalances in treatment assignment. Freedom from local progression (FFLP) and toxicity were retrospectively analyzed.Results RFA and SBRT groups were similar with respect to number of lesions treated per patient, type of underlying liver disease, and tumor size (median, 1.8 v 2.2 cm in maximum diameter; P = .14). However, the SBRT group had lower pretreatment Child-Pugh scores (P = .003), higher pretreatment alpha-fetoprotein levels (P = .04), and a greater number of prior liver-directed treatments (P , .001). One-and 2-year FFLP for tumors treated with RFA were 83.6% and 80.2% v 97.4% and 83.8% for SBRT. Increasing tumor size predicted for FFLP in patients treated with RFA (hazard ratio [HR], 1.54 per cm; P = .006), but not with SBRT (HR, 1.21 per cm; P = .617). For tumors $ 2 cm, there was decreased FFLP for RFA compared with SBRT (HR, 3.35; P = .025). Acute grade 3+ complications occurred after 11% and 5% of RFA and SBRT treatments, respectively (P = .31). Overall survival 1 and 2 years after treatment was 70% and 53% after RFA and 74% and 46% after SBRT. ConclusionBoth RFA and SBRT are effective local treatment options for inoperable HCC. Although these data are retrospective, SBRT appears to be a reasonable first-line treatment of inoperable, larger HCC.

Combination of radiation and interleukin 12 eradicates large orthotopic hepatocellular carcinoma through immunomodulation of tumor microenvironment

“…Stereotactic body radiotherapy (SBRT) is an emerging radiotherapy technique that safely and effectively treats HCC by delivering large dose of radiation (6–15 Gy per fraction, as used in our RT/IL-12 protocol) to liver tumors in 1–6 fractions. 45 SBRT is believed to achieve tumor control via its effects on vascular, stromal and immunological aspects of the tumor microenvironment. 46 The early clinical success of combining RT with systemic therapy to treat advanced HCC marks the promise of RT-containing multimodality protocols for this dismal disease.…”

Advances in Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma

“…CBCT matching has been suggested to be superior to orthogonal x-rays 56 . The use of peri-tumoral fiducials, with both x-rays and CBCT can further enhance set-up 21,26,31,32,34,52,57 . The presence of lipiodal following TACE, or surgical clips, have also been used as surrogates for tumour position 21,26 .…”

Radiation therapy for hepatobiliary malignancies

“…A recent retrospective study of 224 patients from the University of Michigan compared outcomes in patients undergoing either RFA or SBRT. The authors reported that while local control did not vary with tumor size for SBRT, lesions greater than 2 cm in maximal diameter had worse local control when treated with RFA (13). On multivariate analysis, RFA was associated with a hazard ratio of 3.84 (P=0.002) for local progression when compared to SBRT, and overall rates of local progression were higher with RFA.…”