Loyola University Medical Center, Maywood.
Department of Radiation Oncology Northwestern Medical Group Northwestern Memorial Hospital Northwestern University Feinberg School of Medicine Northwestern Memorial Hospital, Chicago, IL.
Am J Clin Oncol. 2024 Mar 1;47(3):99-104. doi: 10.1097/COC.0000000000001064. Epub 2023 Nov 20.
Stereotactic Body Radiotherapy (SBRT) and Yttrium-90 (Y90) are among the ablative therapies used as treatment options for localized hepatocellular carcinoma (HCC). To date, direct comparisons of the 2 modalities' outcomes and costs are lacking. This study aimed to analyze demographic, treatment, and cost information for patients with HCC treated with SBRT and Y90.
Patients with HCC treated with SBRT or Y90 radioembolization between January 2018 and January 2020 at one institution were retrospectively reviewed. Demographic and treatment data were compared utilizing χ 2 tests. Kaplan-Meier curves and log-rank tests were applied to compare overall survival and progression-free survival in different treatment groups. Cox proportional hazard models were applied to analyze the unadjusted and adjusted survival differences. Ten SBRT and 10 Y90 patients were randomly selected for Medicare cost analysis.
Sixty-three patients received Y90, and 21 received SBRT. On univariable and multivariable analysis, there was no significant difference in overall survival or progression-free survival between the Y90 and SBRT cohorts. SBRT patients had higher American Joint Committee on Cancer staging ( P =0.039), greater tumor size (4.07 vs. 2.96 cm, P =0.013), and greater rates of prior liver-directed therapy (71.4% SBRT vs. 12.7% Y90, P <0.001). The average cost for SBRT was $15,148, and Y90 was $41,360.
SBRT and Y90 are effective therapies in the treatment of HCC, specifically having similar overall survival and progression-free survival. Y90 was found to have a significantly higher cost than SBRT. This study demonstrates the need for prospective studies to assess these modalities in treating HCC.
立体定向体部放射疗法（SBRT）和钇-90（Y90）是用于治疗局限性肝细胞癌（HCC）的消融治疗方法之一。迄今为止，还缺乏这两种治疗方法的结果和成本的直接比较。本研究旨在分析在一家医疗机构接受 SBRT 和 Y90 放射性栓塞治疗的 HCC 患者的人口统计学、治疗和成本信息。
回顾性分析了 2018 年 1 月至 2020 年 1 月期间在一家医疗机构接受 SBRT 或 Y90 放射性栓塞治疗的 HCC 患者。利用 χ2检验比较人口统计学和治疗数据。应用 Kaplan-Meier 曲线和对数秩检验比较不同治疗组的总生存期和无进展生存期。应用 Cox 比例风险模型分析未调整和调整后的生存差异。随机选择了 10 名 SBRT 患者和 10 名 Y90 患者进行医疗保险成本分析。
63 名患者接受了 Y90 治疗，21 名患者接受了 SBRT 治疗。在单变量和多变量分析中，Y90 和 SBRT 两组之间的总生存期或无进展生存期无显著差异。SBRT 患者的美国癌症联合委员会分期更高（P=0.039），肿瘤更大（4.07 厘米比 2.96 厘米，P=0.013），且先前接受过肝定向治疗的比例更高（71.4% SBRT 比 12.7% Y90，P<0.001）。SBRT 的平均费用为 15148 美元，Y90 的费用为 41360 美元。
SBRT 和 Y90 是治疗 HCC 的有效治疗方法，特别是在总生存期和无进展生存期方面相似。Y90 的成本明显高于 SBRT。本研究表明需要进行前瞻性研究来评估这些方法在治疗 HCC 中的作用。
