Both stereotactic body radiotherapy (SBRT) and radiofrequency ablation (RFA) are effective local options for inoperable hepatocellular carcinoma (HCC), a new study published online ahead of print in the Journal of Clinical Oncology has shown.1
Because there is limited evidence guiding selection of nonsurgical treatment of HCC, researchers at University Michigan Medical Center and Veteran Affairs Medical Center in Ann Arbor, MI, sought to compare outcomes between SBRT and RFA for HCC.
For the study, researchers analyzed data from 224 patients with inoperable, nonmetastatic HCC who underwent RFA or image-guided SBRT. A total of 249 tumors received RFA and 83 tumors had SBRT.
The number of lesions treated per patient, type of underlying liver disease, and tumor size were similar in both groups, but the SBRT group had lower pretreatment Child-Pugh scores, higher pretreatment alpha-fetoprotein levels, and a greater number of prior liver-directed treatments.
Results showed that 1- and 2-year freedom from local progression for tumors treated with RFA were 83.6% and 80.2%, respectively, compared with 97.4% and 83.3%, respectively, for tumors treated with SBRT. One- and 2-year overall survival after treatment was 70% and 53%, respectively, after RFA and 74% and 46%, respectively, after SBRT.
Researchers found that increased tumor size was associated with freedom from local progression in patients treated with RFA (HR, 1.54 per cm; P = .006), but not in patients treated with SBRT (HR, 1.21 per cm; P = .617). However, for tumors 2 cm or larger, freedom from local progression for tumors treated with RFA was decreased compared with tumors treated with SBRT (HR, 3.35; P = .025).
In regard to safety, acute grade 3 or greater complications occurred after 11% of RFA treatments and 5% of SBRT treatments (P = .31).
“Although these data are retrospective, SBRT appears to be a reasonable first-line treatment of inoperable, larger HCC,” the authors concluded.
- Wahl DR, Stenmark MH, Tao Y, Pollom EL, et al. Outcomes after stereotactic body radiotherapy or radiofrequency ablation for hepatocellular carcinoma [published online ahead of print November 30, 2015]. J Clin Oncol. doi: 10.1200/JCO.2015.61.4925.