한빛사 논문
Nalee Kim1, Jason Cheng2, Inkyung Jung3, Ja Der Liang4, Yu Lueng Shih5, Wen-Yen Huang6, Tomoki Kimura7, Victor HF.Lee8, Zhao Chong Zeng9, Ren Zhenggan10, Chul Seung Kay11, Seok Jae Heo3, Jong Yoon Won1,2, Jinsil Seong1,*
1Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Republic of Korea
2Department of Radiation Oncology, National Taiwan University Hospital, Taiwan
3Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
4Department of Internal Medicine, National Taiwan University Hospital, Taiwan
5Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan
6Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taiwan
7Department of Radiation Oncology, Hiroshima University Hospital, Japan
8Department of Radiation Oncology, The University of Hong Kong, Hong Kong
9Department of Radiation Oncology, Zhongshan Hospital, Fudan University, China
10Department of Medical Hepatology, Zhongshan Hospital, Fudan University, China
11Department of Radiation Oncology, Incheon St. Mary Hospital, Republic of Korea
12Department of Interventional Radiology, Yonsei Cancer Center, Yonsei University College of Medicine, Republic of Korea
*Corresponding author
Abstract
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.
Methods
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).
Results
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).
Conclusions
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.
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