Stereotactic Body Radiation Therapy as an Alternative Treatment for Patients with Hepatocellular Carcinoma Compared to Sorafenib: A Propensity Score Analysis

Abstract

<b><i>Background and Aims:</i></b> Stereotactic body radiation therapy (SBRT) has emerged as a safe and effective treatment for patients with hepatocellular carcinoma (HCC), but its role in patients with advanced HCC is not yet defined. In this study, we aim to assess the efficacy and safety of SBRT in comparison to sorafenib treatment in patients with advanced HCC. <b><i>Methods:</i></b> We included 901 patients treated with sorafenib at six tertiary centers in Europe and Asia and 122 patients treated with SBRT from 13 centers in Germany and Switzerland. Medical records were reviewed including laboratory parameters, treatment characteristics and development of adverse events. Propensity score matching was performed to adjust for differences in baseline characteristics. The primary endpoint was overall survival (OS) and progression-free survival. <b><i>Results:</i></b> Median OS of SBRT patients was 18.1 (10.3–25.9) months compared to 8.8 (8.2–9.5) in sorafenib patients. After adjusting for different baseline characteristics, the survival benefit for patients treated with SBRT was still preserved with a median OS of 17.0 (10.8–23.2) months compared to 9.6 (8.6–10.7) months in sorafenib patients. SBRT treatment of intrahepatic lesions in patients with extrahepatic metastases was also associated with improved OS compared to patients treated with sorafenib in the same setting (17.0 vs. 10.0 months, <i>p</i> = 0.012), whereas in patients with portal vein thrombosis there was no survival benefit in patients with SBRT. <b><i>Conclusions:</i></b> In this retrospective comparative study, SBRT showed superior efficacy in HCC patients compared to patients treated with sorafenib.

Development and Validation of a Nomogram for Patients with Nonmetastatic BCLC Stage C Hepatocellular Carcinoma after Stereotactic Body Radiotherapy

“…Recently, several prospective studies have reported an encouraging outcome of stereotactic body radiotherapy (SBRT) for selected HCC patients with response rates of 40-70% (complete and partial responses), 1-year local control rates of 75-95%, and OS rates of 55-94% [5][6][7][8][9][10]. A randomized trial on the comparison between sorafenib alone and transcatheter arterial chemoembolization (TACE) followed by fractionated radiotherapy (RT) demonstrated superior response and survival by TACE plus RT and supported the role of RT in the multimodality treatments of patients with macrovascular invasion (MVI) [11].…”

Comparison of local tumor control in patients with HCC treated with SBRT or TACE: a propensity score analysis

“…The SBRT cohort consisted of 35 consecutive patients with 49 HCC lesions who have been treated in the Department of Radiation Oncology of the University Hospital Freiburg (Germany) between 2012 and 2016 and which have partly been published elsewhere [ 6 , 13 ]. Patients treated with SBRT who received prior TACE were not included in the TACE group.…”

“…In order to exactly define the radiation field, patients were immobilized in supine position with a vacuum cushion (BlueBAG BodyFIX, Innovative Technologies Völp, Innsbruck, Austria) and underwent 4 dimensional-CT (4D CT, Brilliance CT Big Bore, Philips Medical Systems, Cleveland, OH) as previously described [ 6 , 13 ]. For the 4D acquisition (Mayo Clinic Respiratory feedback system), we monitored breathing which was reduced with an abdominal compression method.…”

“…Radiological response was assessed every 3 months after TACE or SBRT by using the mRECIST criteria (version 1.1) [ 13 ]. Complete remission, partial remission or stable disease was summarized as local tumor control (LC).…”

Monozentrische Erfahrungen mit stereotaktischer Bestrahlung (SBRT) beim fortgeschrittenen hepatozellulären Karzinom im Stadium BCLC-C

“…In einer retrospektiv durchgeführten Propensity-Score-Analyse wurden 122 Patienten, die mittels SBRT behandelt worden sind, mit Patienten unter Sorafenib-Therapie verglichen. Die Ergebnisse deuteten auf ein verbessertes mittleres Gesamtüberleben von 17,0 Monaten (10,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)2) im Vergleich zu den mit Sorafenib behandelten Patienten von 9,6 Monaten (8,6-10,7) hin [36]. Trotz der vielversprechenden Ergebnisse sind jedoch das retrospektive Studiendesign der Studie und die limitierte Anzahl an Patienten zu beachten, sodass Ergebnisse von prospektiven Studien abzuwarten sind.…”