Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Republic of Korea.
Department of Radiation Oncology, National Taiwan University Hospital, Taiwan.
J Hepatol. 2020 Jul;73(1):121-129. doi: 10.1016/j.jhep.2020.03.005. Epub 2020 Mar 10.
BACKGROUND & AIMS: Few studies have been conducted to compare the efficacies of stereotactic body radiation therapy (SBRT) and radiofrequency ablation (RFA). Thus, in this multinational study, we compared the effectiveness of SBRT and RFA in patients with unresectable HCC.
The retrospective study cohort included 2,064 patients treated in 7 hospitals: 1,568 and 496 in the RFA and SBRT groups, respectively. More than half of the patients (56.5%) developed recurrent tumors, mainly after transarterial chemoembolization (44.8%). Propensity score matching was performed to adjust for clinical factors (n = 313 in each group).
At baseline, the SBRT group had unfavorable clinical features compared to the RFA group, including BCLC stage (B-C 65% vs. 16%), tumor size (median 3.0 cm vs. 1.9 cm), and frequent history of liver-directed treatment (81% vs. 49%, all p <0.001). With a median follow-up of 27.7 months, the 3-year cumulative local recurrence rates in the SBRT and RFA groups were 21.2% and 27.9%, respectively (p <0.001). After adjusting for clinical factors, SBRT was related to a significantly lower risk of local recurrence than RFA in both the entire (hazard ratio [HR] 0.45, p <0.001) and matched (HR 0.36, p <0.001) cohorts. In subgroup analysis, SBRT was associated with superior local control in small tumors (≤3 cm) irrespective of location, large tumors located in the subphrenic region, and those that progressed after transarterial chemoembolization. Acute grade ≥3 toxicities occurred in 1.6% and 2.6% of the SBRT and RFA patients, respectively (p = 0.268).
SBRT could be an effective alternative to RFA for unresectable HCC, particularly for larger tumors (>3 cm) in a subphrenic location and tumors that have progressed after transarterial chemoembolization.
It is currently not known what the best treatment option is for patients with unresectable hepatocellular carcinoma. Here, we show that stereotactic body radiation therapy provides better local control than radiofrequency ablation, with comparable toxicities. Stereotactic body radiation therapy appears to be an effective alternative to radiofrequency ablation that should be considered when there is a higher risk of local recurrence or toxicity after radiofrequency ablation.
鲜有研究比较立体定向体部放疗（SBRT）和射频消融（RFA）的疗效。因此，在这项多中心研究中，我们比较了不能切除的 HCC 患者接受 SBRT 和 RFA 的疗效。
回顾性研究队列纳入了 7 家医院的 2064 例患者：RFA 组和 SBRT 组分别为 1568 例和 496 例。超过一半的患者（56.5%）出现肿瘤复发，主要是在经动脉化疗栓塞（TACE）后（44.8%）。对临床因素进行倾向评分匹配（每组 313 例）。
在基线时，与 RFA 组相比，SBRT 组具有不利的临床特征，包括巴塞罗那临床肝癌分期（BCLC 期 B-C 65% vs. 16%）、肿瘤大小（中位数 3.0 cm vs. 1.9 cm）和频繁的肝定向治疗史（81% vs. 49%，均 p <0.001）。中位随访 27.7 个月后，SBRT 和 RFA 组的 3 年累积局部复发率分别为 21.2%和 27.9%（p <0.001）。在调整临床因素后，SBRT 与 RFA 相比，在整个队列（风险比[HR]0.45，p <0.001）和匹配队列（HR 0.36，p <0.001）中局部复发的风险显著降低。亚组分析显示，SBRT 与局部控制相关，无论肿瘤大小（≤3 cm）、位于膈下的大肿瘤，还是 TACE 后进展的肿瘤，SBRT 均优于 RFA。SBRT 和 RFA 组分别有 1.6%和 2.6%的患者出现急性 3 级以上毒性（p=0.268）。
SBRT 可能是不能切除 HCC 的有效替代治疗方法，尤其是对于位于膈下的较大肿瘤（>3 cm）和 TACE 后进展的肿瘤。
目前尚不清楚不能切除的肝细胞癌患者的最佳治疗选择是什么。在这里，我们表明立体定向体部放疗提供了比射频消融更好的局部控制效果，且毒性相当。立体定向体部放疗似乎是射频消融的有效替代方法，当射频消融后局部复发或毒性风险较高时，应考虑使用立体定向体部放疗。
