Department of Internal Medicine, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, South Korea.
Department of Internal Medicine, Soonchunhyang University College of Medicine Bucheon Hospital, Bucheon, South Korea.
PLoS One. 2018 Oct 31;13(10):e0206381. doi: 10.1371/journal.pone.0206381. eCollection 2018.
Patients with liver cirrhosis and hepatocellular carcinoma (HCC) are often ineligible for resection or local ablation therapy due to poor liver function and/or difficult location. The aim of this study is to evaluate therapeutic outcomes of stereotactic body radiotherapy (SBRT) combined with transarterial chemoembolization (TACE) compared with TACE alone for HCC measuring less than 5 cm. From March 2011 to December 2016, 85 patients underwent SBRT with TACE (SBRT-TACE group) and 114 underwent TACE (TACE group) at 4 tertiary hospitals. Local control rate (LCR), progression-free survival (PFS) and overall survival (OS) were compared after propensity-score matching (1:1 ratio). The SBRT-TACE group showed significantly higher 1- and 3-year LCR than the TACE group (91.1% and 89.9%, respectively vs 69.9% and 44.8%, respectively; P < 0.001). The SBRT-TACE group showed better 1- and 3-year PFS than the TACE group (56.5% and 32.3%, respectively vs 42.2% and 21.6%, respectively; P = 0.022). However, 1-, 3- and 5-year OS was not different between the SBRT-TACE and TACE groups (98.8%, 89.1% and 80.7%, respectively vs 99.7%, 83.3% and 71.0%, respectively; P = 0.206). In multivariate analysis, the overall SBRT added to TACE did not contribute to extend PFS. However, in patients with less than 2 tumors, the combined therapy was effective (HR 0.590, 95% CI 0.392-0.889, P = 0.012). SBRT-TACE is superior to TACE in terms of LCR. Particularly, SBRT-TACE may be an effective alternative in patients with HCC number (≤2), which is not indicated for resection or local ablation.
患者患有肝硬化和肝细胞癌（HCC）通常由于肝功能不佳和/或位置困难而不适合进行切除术或局部消融治疗。本研究的目的是评估立体定向体部放疗（SBRT）联合经动脉化疗栓塞（TACE）与单独 TACE 治疗小于 5cm 的 HCC 的治疗效果。2011 年 3 月至 2016 年 12 月，4 家三级医院的 85 例患者接受 SBRT 联合 TACE（SBRT-TACE 组），114 例患者接受 TACE（TACE 组）。通过倾向评分匹配（1:1 比例）比较局部控制率（LCR）、无进展生存期（PFS）和总生存期（OS）。SBRT-TACE 组的 1 年和 3 年 LCR 明显高于 TACE 组（分别为 91.1%和 89.9%，分别为 69.9%和 44.8%；P<0.001）。SBRT-TACE 组的 1 年和 3 年 PFS 明显优于 TACE 组（分别为 56.5%和 32.3%，分别为 42.2%和 21.6%；P=0.022）。然而，SBRT-TACE 组与 TACE 组的 1 年、3 年和 5 年 OS 无差异（分别为 98.8%、89.1%和 80.7%，分别为 99.7%、83.3%和 71.0%；P=0.206）。多因素分析表明，总体上 SBRT 联合 TACE 并不能延长 PFS。然而，在肿瘤数量（≤2）较少的患者中，联合治疗是有效的（HR 0.590，95%CI 0.392-0.889，P=0.012）。SBRT-TACE 在 LCR 方面优于 TACE。特别是，SBRT-TACE 可能是不适合手术切除或局部消融治疗的 HCC 数量（≤2）患者的有效替代治疗方法。
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