Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan.
Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Japan.
Hepatology. 2019 Jun;69(6):2533-2545. doi: 10.1002/hep.30591. Epub 2019 May 2.
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.
根治性治疗方法对早期肝细胞癌（HCC）存在局限性和禁忌证。最近，放射治疗取得了较好的效果。我们比较了放射治疗和射频消融（RFA）治疗早期 HCC 的效果。回顾性分析了连续接受 RFA 或放射治疗的≤3 个早期 HCC 病变和肿瘤直径≤3cm 的患者。RFA 是不适合手术的 HCC 的首选治疗方法。否则，主要采用 5 次分割的立体定向体部放射治疗。对于靠近胃肠道的 HCC，采用轻度适形分割放射治疗。采用倾向评分匹配来减少 RFA 和放射治疗组之间的选择偏倚。2012 年至 2016 年，共有 231 例患者的 474 个肿瘤和 143 例患者的 221 个肿瘤符合条件，分别接受 RFA 和放射治疗。在未匹配的比较中，放疗组的 3 年局部复发率明显低于 RFA 组（5.3%；95%置信区间 [CI]，2.7-9.2；12.9%，95% CI，9.9-16.2）（P<0.01）。对每组 106 例患者进行倾向评分匹配分析，成功地对两组治疗进行了匹配，包括巴塞罗那临床肝癌分期、T 分期和肿瘤大小，但不能匹配肿瘤与危险器官的毗邻程度或首次治疗或挽救性治疗。RFA 和放疗患者的 3 年总生存率相当（RFA 组为 69.1%；95%CI，58.2-77.7；放疗组为 70.4%；95%CI，58.5-79.4；P=0.86）。结论：对于肝功能良好的患者，放射治疗具有出色的局部控制和相当的总生存率，具有有利的特点，并弥补了其他治疗方法的不足；放射治疗似乎是 RFA 不适用患者的可接受的替代治疗选择。
