In an individual patient analysis reported in the Journal of Clinical Oncology, Moon et al found that treatment of early-stage hepatocellular carcinoma (HCC) with external-beam radiation therapy (EBRT) was associated with survival outcomes comparable to other treatment modalities such as surgical resection, thermal ablation, and other ablative locoregional therapies.
Study Details
The study involved patient-level data from studies that assessed EBRT, met prespecified technical standards for HCC, and assessed overall survival through December 2022. Analyses were stratified by Barcelona Clinic Liver Cancer (BCLC) stage and treatment-naive status.
Key Findings
A total of 4,913 patients were included in the analysis, with a median follow-up of 5.0 years.
Median overall survival was 6.8 years (95% confidence interval [CI] = 5.7–8.7 years) among patients with BCLC-0 disease (n = 484) and 4.6 years (95% CI = 4.1–5.1 years) among those with BCLC-A disease (n = 1,123). Among treatment-naive patients with BCLC-0 disease (n = 134), median overall survival was not reached (95% CI = 8.6 years to not reached). Among treatment-naive patients with BCLC-A disease (n = 468), median overall survival was 5.4 years (95% CI = 4.5–6.7 years).
In multivariable analyses, more advanced BCLC stage, higher tumor burden, worse performance status, and Child-Pugh class B or C were associated with a higher risk of mortality. Ablative radiation dose and more recent year of treatment were associated with a reduced risk of mortality.
The investigators concluded: “To our knowledge, this study represents the largest multinational cohort of patients with HCC treated with EBRT. [Overall survival] outcomes with EBRT for very early- and early-stage HCC appear to be comparable with resection, thermal ablation, and other ablative locoregional therapies. These data support the inclusion of EBRT in the BCLC HCC clinical decision-making process.”
Maria Reig, MD, PhD, of Liver Cancer Unit, Liver Unit, Hospital Clinic, BCLC Group—IDIBAPS, CIBEREHD, Barcelona University, Barcelona, Spain, is the corresponding author for the Journal of Clinical Oncology article.
DISCLOSURE: The study was supported by a grant from the American College of Gastroenterology and an award from the American Association for the Study of Liver Disease. For full disclosures of the study authors, visit ascopubs.org.
