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Stereotactic Body Radiotherapy vs Radiofrequency Ablation in Inoperable Nonmetastatic Hepatocellular Carcinoma

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Key Points

  • Increasing tumor size was significantly predictive of local failure with radiofrequency ablation but not with stereotactic body radiotherapy in patients with inoperable nonmetastatic larger hepatocellular carcinoma.
  • For tumors 2 cm, risk of local tumor progression was threefold greater with radiofrequency ablation.

In a single-institution retrospective study reported in the Journal of Clinical Oncology, Wahl et al found that stereotactic body radiotherapy may provide better freedom from local tumor progression vs radiofrequency ablation in patients with inoperable nonmetastatic larger hepatocellular carcinoma.

Study Details

The study involved data from 224 patients with inoperable, nonmetastatic hepatocellular carcinoma undergoing radiofrequency ablation to 249 tumors in 161 patients and image-guided stereotactic body radiotherapy to 83 tumors in 63 patients at the University of Michigan between 2004 and 2012. Inverse probability of treatment weighting was used to adjust for imbalances in treatment assignment.

The radiofrequency ablation and stereotactic body radiotherapy groups had similar numbers of lesions treated per patient, types of underlying liver disease, and tumor size (median = 1.8 vs 2.2 cm in maximum diameter, P = .14). The stereotactic body radiotherapy group had a lower pretreatment Child-Pugh score (P = .003), a higher pretreatment alpha-fetoprotein level (P = .04), and a greater number of prior liver-directed treatments (P < .001).

Freedom From Local Tumor Progression

One- and 2-year freedom from local tumor progression was 83.6% and 80.2% for tumors treated with radiofrequency ablation vs 97.4% and 83.8% for those treated with stereotactic body radiotherapy. On inverse probability of treatment weighting univariate analysis, the treatment modality was associated with local tumor progression (hazard ratio [HR] = 2.63, P = .016, for radiofrequency ablation vs stereotactic body radiotherapy).

After adjustment for treatment type, tumor size was the only covariate predictive of local tumor progression (HR = 1.36/cm, P = .029), with neither Child-Pugh score nor number of previous treatments being a significant predictor. Increasing tumor size was significantly predictive of failure with radiofrequency ablation (HR = 1.54/cm, P = .006) but not with stereotactic body radiotherapy (HR = 1.21/cm, P = .617). For tumors 2 cm, freedom from local tumor progression was significantly reduced with radiofrequency ablation vs stereotactic body radiotherapy (HR = 3.35, P = .025).

Acute grade 3+ complications occurred after 11% of radiofrequency ablation treatments and 5% of stereotactic body radiotherapy treatments (P = .31). Overall survival at 1 and 2 years after treatment was 70% and 53% with radiofrequency ablation and 74% and 46% with stereotactic body radiotherapy, respectively.

The investigators concluded: “Both radiofrequency ablation and stereotactic body radiotherapy are effective local treatment options for inoperable hepatocellular carcinoma. Although these data are retrospective, stereotactic body radiotherapy appears to be a reasonable first-line treatment of inoperable, larger hepatocellular carcinoma.”

The study was supported by the National Institutes of Health and Taubman Institute.

Mary Feng, MD, of the University of Michigan Medical Center, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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