Bettinger Dominik, Pinato David J, Schultheiss Michael, Sharma Rohini, Rimassa Lorenza, Pressiani Tiziana, Burlone Michela E, Pirisi Mario, Kudo Masatoshi, Park Joong Won, Buettner Nico, Neumann-Haefelin Christoph, Boettler Tobias, Abbasi-Senger Nasrin, Alheit Horst, Baus Wolfgang, Blanck Oliver, Gerum Sabine, Guckenberger Mathias, Habermehl Daniel, Ostheimer Christian, Riesterer Oliver, Tamihardja Jörg, Grosu Anca-Ligia, Thimme Robert, Brunner Thomas Baptist, Gkika Eleni
Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Berta-Ottenstein Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Liver Cancer. 2019 Jul;8(4):281-294. doi: 10.1159/000490260. Epub 2018 Jul 12.
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.
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.
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, = 0.012), whereas in patients with portal vein thrombosis there was no survival benefit in patients with SBRT.
In this retrospective comparative study, SBRT showed superior efficacy in HCC patients compared to patients treated with sorafenib.
立体定向体部放射治疗（SBRT）已成为肝细胞癌（HCC）患者安全有效的治疗方法，但其在晚期HCC患者中的作用尚未明确。在本研究中，我们旨在评估SBRT与索拉非尼治疗晚期HCC患者的疗效和安全性。
我们纳入了欧洲和亚洲六个三级中心接受索拉非尼治疗的901例患者以及德国和瑞士13个中心接受SBRT治疗的122例患者。回顾了病历，包括实验室参数、治疗特征和不良事件的发生情况。进行倾向评分匹配以调整基线特征的差异。主要终点是总生存期（OS）和无进展生存期。
SBRT患者的中位OS为18.1（10.3 - 25.9）个月，而索拉非尼患者为8.8（8.2 - 9.5）个月。在调整不同基线特征后，接受SBRT治疗患者的生存获益仍然存在，中位OS为17.0（10.8 - 23.2）个月，而索拉非尼患者为9.6（8.6 - 10.7）个月。与在相同情况下接受索拉非尼治疗的患者相比，SBRT治疗肝外转移患者的肝内病变也与OS改善相关（17.0对10.0个月，P = 0.012），而在门静脉血栓形成患者中，SBRT患者无生存获益。
在这项回顾性比较研究中，与接受索拉非尼治疗的患者相比，SBRT在HCC患者中显示出更好的疗效。
