Radiotherapy for Hepatocellular Carcinoma Results in Comparable Survival to Radiofrequency Ablation: A Propensity Score Analysis

Abstract

Potentially curative treatments for early‐stage hepatocellular carcinoma (HCC) have drawbacks and contraindications. Recently, radiotherapy has achieved good outcomes. We compared the outcomes of radiotherapy and radiofrequency ablation (RFA) for early‐stage HCC. Consecutive patients with ≤3 early‐stage HCC lesions and tumor diameters ≤3 cm treated with RFA or radiotherapy were reviewed. RFA was the first choice for HCC unsuitable for surgery. Otherwise, stereotactic body radiotherapy in five fractions was mainly performed. For HCC adjacent to the gastrointestinal tract, radiotherapy with mild hypofractionation was performed. Propensity score matching was performed to reduce the selection bias between the RFA and radiotherapy groups. Between 2012 and 2016, a total of 231 patients with 474 tumors and 143 patients with 221 tumors were eligible and were treated with RFA and radiotherapy, respectively. In an unmatched comparison, the 3‐year local recurrence rate was significantly lower for radiotherapy than for RFA (5.3%; 95% confidence interval [CI], 2.7‐9.2; versus 12.9%, 95% CI, 9.9‐16.2) (P < 0.01). A propensity score matching analysis of 106 patients in each group successfully matched the two treatment groups with regard to Barcelona Clinic Liver Cancer staging, T stage, and tumor size but not the adjacency of the tumor to risk organs or first or salvage treatment. The 3‐year overall survival rates for RFA and radiotherapy patients were comparable (69.1%; 95% CI, 58.2‐77.7; and 70.4%; 95% CI, 58.5‐79.4, respectively; P = 0.86). Conclusion: Radiotherapy has excellent local control and comparable overall survival in patients with well‐compensated liver function, exhibiting advantageous characteristics and compensating for the deficiencies of other treatment modalities; radiotherapy appears to be an acceptable alternative treatment option for patients who are not candidates for RFA.

Stereotactic body radiotherapy vs radiofrequency ablation in the treatment of hepatocellular carcinoma: a meta-analysis

“…The titles and abstracts of 270 studies were then screened for inclusion. The full texts of 36 studies were read and, finally, we included 10 non-randomized controlled trial (Non-RCT) studies that met the present metaanalysis criteria (3,10,(13)(14)(15)(16)18,19,21,22). The details of PRISMA flow diagram of the literature for meta-analysis is shown in Supplementary Figure S1 (23).…”

“…In present analysis, 3 studies were based on already existed database (13,15,19) and the remaining 7 studies were based on retrospective studies (3,10,(16)(17)(18)21,22). 2 studies conducted SBRT or RFA for transplant intent.…”

“…Overall Survival 9 studies with 2700 patients compared OS rates of SBRT group with RFA group (3,10,13,(15)(16)(17)19,21,22), 1 study with 280 patients were excluded as both SBRT and RFA were applied as bridge therapies before transplantation and thus the actual OS rates of SBRT or RFA might be affected by subsequent transplantation(3). Heterogeneity was low for the studies that reported 1-and 2-year OS rates (χ 2 = 10.47, I 2 = 33%; χ 2 = 7.93, I 2 = 24%, respectively), so the fixed effect model was used to pool the outcomes.…”

“…Prognosis for treatment allocation 3 and 5 studies evaluated the results of treatment allocation as a prognostic factor for LP (10,16,17) and OS (13,15,17,19,21), respectively. The treatment allocation was not a prognostic factor for LP [HR 0.80, 95% IC 0.58 to 1.09, P = 0.160].…”

“…The main finding of this meta-analysis is that SBRT showed a better local control than RFA for patients with HCC, though the 1-and 2-year OS rates of SBRT were inferior because of the tumor burden and liver profiles. Recently, RFA, as a traditional curable treatment, was challenged by SBRT (15,21,22).…”