Outcomes After Stereotactic Body Radiotherapy or Radiofrequency Ablation for Hepatocellular Carcinoma.

PURPOSE Data guiding selection of nonsurgical treatment of hepatocellular carcinoma (HCC) are lacking. We therefore compared outcomes between stereotactic body radiotherapy (SBRT) and radiofrequency ablation (RFA) for HCC. PATIENTS AND METHODS From 2004 to 2012, 224 patients with inoperable, nonmetastatic HCC underwent RFA (n = 161) to 249 tumors or image-guided SBRT (n = 63) to 83 tumors. We applied inverse probability of treatment weighting to adjust for imbalances in treatment assignment. Freedom from local progression (FFLP) and toxicity were retrospectively analyzed. RESULTS RFA and SBRT groups were similar with respect to number of lesions treated per patient, type of underlying liver disease, and tumor size (median, 1.8 v 2.2 cm in maximum diameter; P = .14). However, the SBRT group had lower pretreatment Child-Pugh scores (P = .003), higher pretreatment alpha-fetoprotein levels (P = .04), and a greater number of prior liver-directed treatments (P < .001). One- and 2-year FFLP for tumors treated with RFA were 83.6% and 80.2% v 97.4% and 83.8% for SBRT. Increasing tumor size predicted for FFLP in patients treated with RFA (hazard ratio [HR], 1.54 per cm; P = .006), but not with SBRT (HR, 1.21 per cm; P = .617). For tumors ≥ 2 cm, there was decreased FFLP for RFA compared with SBRT (HR, 3.35; P = .025). Acute grade 3+ complications occurred after 11% and 5% of RFA and SBRT treatments, respectively (P = .31). Overall survival 1 and 2 years after treatment was 70% and 53% after RFA and 74% and 46% after SBRT. CONCLUSION Both RFA and SBRT are effective local treatment options for inoperable HCC. Although these data are retrospective, SBRT appears to be a reasonable first-line treatment of inoperable, larger HCC.

[1]  V. Mazzaferro,et al.  Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. , 1996, The New England journal of medicine.

[2]  Luigi Solbiati,et al.  Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: Is resection still the treatment of choice? , 2007, Hepatology.

[3]  W. Lau,et al.  A Prospective Randomized Trial Comparing Percutaneous Local Ablative Therapy and Partial Hepatectomy for Small Hepatocellular Carcinoma , 2006, Annals of surgery.

[4]  J. Balter,et al.  Stereotactic body radiation therapy for primary and metastatic liver tumors. , 2013, Translational oncology.

[5]  S. Fan,et al.  Long-Term Survival and Pattern of Recurrence After Resection of Small Hepatocellular Carcinoma in Patients With Preserved Liver Function: Implications for a Strategy of Salvage Transplantation , 2002, Annals of surgery.

[6]  Andrea Bezjak,et al.  The impact of tumor size on outcomes after stereotactic body radiation therapy for medically inoperable early-stage non-small cell lung cancer. , 2013, International journal of radiation oncology, biology, physics.

[7]  M. Bloomston,et al.  Microwave Ablation for Hepatic Malignancies: A Multiinstitutional Analysis , 2014, Annals of surgery.

[8]  Jan Nyman,et al.  Factors important for efficacy of stereotactic body radiotherapy of medically inoperable stage I lung cancer. A retrospective analysis of patients treated in the Nordic countries , 2006, Acta oncologica.

[9]  R K Ten Haken,et al.  The reproducibility of organ position using active breathing control (ABC) during liver radiotherapy. , 2001, International journal of radiation oncology, biology, physics.

[10]  J. Vauthey,et al.  Surgical Resection of High-Risk Hepatocellular Carcinoma: Patient Selection, Preoperative Considerations, and Operative Technique , 2010, Annals of Surgical Oncology.

[11]  Zahra Kassam,et al.  Sequential phase I and II trials of stereotactic body radiotherapy for locally advanced hepatocellular carcinoma. , 2013, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[12]  L. Mariani,et al.  Radiofrequency Ablation of Small Hepatocellular Carcinoma in Cirrhotic Patients Awaiting Liver Transplantation: A Prospective Study , 2004, Annals of surgery.

[13]  Jong Hoon Kim,et al.  Stereotactic Body Radiation Therapy as an Alternative Treatment for Small Hepatocellular Carcinoma , 2013, PloS one.

[14]  E. Kunieda,et al.  Stereotactic ablative body radiotherapy for previously untreated solitary hepatocellular carcinoma , 2014, Journal of gastroenterology and hepatology.

[15]  Dong Han Lee,et al.  Preliminary result of stereotactic body radiotherapy as a local salvage treatment for inoperable hepatocellular carcinoma , 2010, Journal of surgical oncology.

[16]  Zhongxing Liao,et al.  Systemic review of the patterns of failure following stereotactic body radiation therapy in early-stage non-small-cell lung cancer: clinical implications. , 2010, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[17]  J. Palmgren,et al.  Estimation of Multivariate Frailty Models Using Penalized Partial Likelihood , 2000, Biometrics.

[18]  L. Gaspar,et al.  Multi-institutional phase I/II trial of stereotactic body radiation therapy for lung metastases. , 2009, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[19]  Yuman Fong,et al.  American Society of Clinical Oncology 2009 clinical evidence review on radiofrequency ablation of hepatic metastases from colorectal cancer. , 2010, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[20]  H. Jang,et al.  Long-term effect of stereotactic body radiation therapy for primary hepatocellular carcinoma ineligible for local ablation therapy or surgical resection. Stereotactic radiotherapy for liver cancer , 2010, BMC Cancer.

[21]  M. Pompili,et al.  Percutaneous ablation procedures in cirrhotic patients with hepatocellular carcinoma submitted to liver transplantation: Assessment of efficacy at explant analysis and of safety for tumor recurrence , 2005, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[22]  W. Helton,et al.  Radiofrequency ablation of primary and metastatic liver tumors: a critical review of the literature. , 2008, American journal of surgery.

[23]  R J Little,et al.  Causal effects in clinical and epidemiological studies via potential outcomes: concepts and analytical approaches. , 2000, Annual review of public health.

[24]  Marc L Kessler,et al.  Use and uncertainties of mutual information for computed tomography/ magnetic resonance (CT/MR) registration post permanent implant of the prostate. , 2005, Medical physics.

[25]  A. Jemal,et al.  Cancer statistics, 2014 , 2014, CA: a cancer journal for clinicians.

[26]  Robert C. G. Martin,et al.  Safety and early efficacy of irreversible electroporation for hepatic tumors in proximity to vital structures , 2013, Journal of surgical oncology.

[27]  Shinichi Shimizu,et al.  Clinical outcomes of stereotactic body radiotherapy for small lung lesions clinically diagnosed as primary lung cancer on radiologic examination. , 2009, International journal of radiation oncology, biology, physics.

[28]  Jacques Ferlay,et al.  Estimating the world cancer burden: Globocan 2000 , 2001, International journal of cancer.