Stereotactic Body Radiotherapy as a Salvage Therapy after Incomplete Radiofrequency Ablation for Hepatocellular Carcinoma: A Retrospective Cohort Study

Abstract

Residual tumor tissue after radiofrequency ablation (RFA) is inevitable in clinical practice, and the optimal management of residual tumor after RFA has not been established. To evaluate the efficiency and toxicity of stereotactic body radiotherapy (SBRT) as a salvage therapy after incomplete RFA for hepatocellular carcinoma (HCC), we retrospectively included 32 HCC patients with an initial incomplete response (iIR) to RFA from May 2011 to August 2018. An iIR was defined as the presence of residual enhancement on CT or MRI one month after RFA treatment. The primary endpoint was local tumor control (LTC); the secondary endpoints included progression-free survival (PFS), overall survival (OS), and toxicity. All patients fulfilled 6 fractions of SBRT as planned, with dosages ranging from 30 Gy to 54 Gy. The objective response rate (ORR) was 50.0%. The 1- and 2-year LTC rates were 86.6% (95% CI, 74.3% to 98.9%) and 74.7% (95% CI, 55.9% to 93.5%), respectively. Fewer times of prior treatments was associated with better LTC (HR = 11.7, P=0.026). The 1- and 2-year PFS rate were 69.9% (95% CI, 53.4% to 86.4%) and 52.7% (95% CI, 33.1% to 72.3%), respectively. A higher Child-Pugh score was the only independent risk factor for tumor progression (HR = 5.17, P=0.012). The 1- and 3-year OS rate were 85.6% and 67.1%, respectively. Only two patients suffered grade 3 adverse events, and none experienced grade 4 or 5 events. In conclusion, for HCC patients confirmed to have an iIR to prior RFA, with compensated liver function, SBRT provided favorable LTC and OS along with acceptable toxicity.

Efficacy and Safety of the Radiotherapy for Liver Cancer: Assessment of Local Controllability and Its Role in Multidisciplinary Therapy

“…Furthermore, the efficacy of TACE + SBRT was comparable to the previously reported local control rate of 88% following the combination of TACE + RFA [ 12 ]. In addition, Fu et al reported the efficacy of SBRT as a salvage therapy after the incomplete RFA [ 13 ]. Recently, Bettinger et al reported that the therapeutic effect of radiotherapy was comparable to that of sorafenib [ 14 ].…”

Optimal Application of Stereotactic Body Radiotherapy and Radiofrequency Ablation Treatment for Different Multifocal Hepatocellular Carcinoma Lesions in Patients With Barcelona Clinic Liver Cancer Stage A4–B1: A Pilot Study

“…Other conditions included lesions adjacent to main portal or hepatic vein (three cases), located close to the heart (two cases), and had poor conspicuity in US and contrast-enhanced ultrasound images (one case). As the risk for insu cient ablation and di cult operation are predictable, we directly planned SBRT as the foremost treatment for these lesions, other than previously using SBRT as a salvage therapy after incomplete RFA performance [18,20], which yielded a 1-3 years' local control rate of 81.8-86.6% and OS rate of 85.4-85.6%. Comparatively, our therapy achieved a much better treatment effect with a high 1-year local control rate (97.4%), a promising prognosis with an acceptable 1-year PFS (80%), and a higher OS rate (100% and 89.9% for 1 and 2 years, respectively).…”

“…Inspired by the previously successful combined application of RFA and SBRT in HCC patients in a relative early stage [18,19], and the requirement for an effective treatment strategy for early multifocal HCCs, especially those ineligible or unavailable for RFA performance, we propose a novel treatment strategy combining SBRT and RFA for different HCC lesions coexisting in the same patient. We performed a retrospective single-arm study by applying RFA and SBRT treatment in 39 multifocal HCC lesions from 15 patients in BCLC stage A4-B1, evaluating the bene t to prognosis and possible adverse effect during follow-up, then determining their comprehensive therapeutic consequences.…”

“…Recently, to overcome the limitations of insu cient ablation in certain locations, an SBRT method to treat post-ablative local progression has been developed. Good results of 1-year local control rate (81.8-86.6%), PFS (63.3-69.9%), and OS (85.4-85.6%) were reported [18]. To treat local recurrence of initial RFA, SBRT was considered to be comparable and more cost-effective than repeated RFA [19], especially for patients with larger tumors or tumors abutting major vessels [20].…”

Safety and efficacy study: Short-term application of radiofrequency ablation and stereotactic body radiotherapy for Barcelona Clinical Liver Cancer stage 0–B1 hepatocellular carcinoma

“…RFA and subsequent SBRT treatment included multifocal lesions treated with RFA and SBRT separately, and local/distant recurrent lesions after RFA treatment were treated with SBRT. For the latter case, a few studies exhibited the feasibility of using SBRT on residual RFA-treated lesions with encouraging outcomes [6,7]. Regrettably, however, there are no data available on the conditions of the short-term application of RFA and SBRT in the same patient for multifocal lesions or intrahepatic distant recurrence, which is very common in the progress of HCC.…”