Background & aims
In this multinational study, we compared the effectiveness of stereotactic body radiation therapy (SBRT) and radiofrequency ablation (RFA) in HCC patients treated at seven hospitals.
The retrospective study cohort included 2064 patients: 1568 and 496 in the RFA and SBRT groups, respectively. More than half of the patients (56.5%) developed recurrent tumors, mainly after transarterial chemoembolization (44.8%). Propensity score matching was performed to adjust for clinical factors (n=313 in each group).
At baseline, the SBRT group had unfavorable clinical features compared to the RFA group, including BCLC stage (B-C, 65% vs. 16%), tumor size (median, 3.0 vs. 1.9 cm), and frequent history of liver-directed treatment (81% vs. 49%, all p<0.001). With a median follow-up of 27.7 months, the 3-year cumulative local recurrence rate (CLRR) in the SBRT and RFA groups were 21.2% and 27.9%, respectively (p<0.001). After adjusting for clinical factors, SBRT was related to a significantly lower risk of local recurrence than RFA in both the entire (hazard ratio [HR] 0.45, p<0.001) and matched (HR 0.36, p<0.001) cohorts. Large tumor size (>3 cm), subphrenic location, and recurrence after transarterial chemoembolization were associated with superior local control in the SBRT group. Acute grade 3+ toxicities occurred in 1.6% and 2.6% of the SBRT and RFA patients, respectively (p=0.268).
SBRT could be an effective alternative to RFA for unresectable HCC when considering tumor size (>3 cm) and subphrenic region, and particularly for those tumors that progress after transarterial chemoembolization.