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Int J Radiat Oncol Biol Phys. 2018 Jan 1;100(1):122-130. doi: 10.1016/j.ijrobp.2017.09.001. Epub 2017 Sep 14.

Stereotactic Body Radiation Therapy as an Alternative to Transarterial Chemoembolization for Hepatocellular Carcinoma.

Author information

1
Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Department of Radiation Oncology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
2
Department of Biostatistics, University of Michigan, Ann Arbor, Michigan.
3
Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
4
Vascular/Interventional Radiology Division, University of Michigan, Ann Arbor, Michigan.
5
Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
6
Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Department of Radiation Oncology, University of California, San Francisco, San Francisco, California. Electronic address: mary.feng@ucsf.edu.

Abstract

PURPOSE:

To conduct a large single-institution comparison of transarterial chemoembolization (TACE) and stereotactic body radiation therapy (SBRT) outcomes in similar groups of patients with hepatocellular carcinoma (HCC).

METHODS AND MATERIALS:

From 2006 to 2014, 209 patients with 1 to 2 tumors underwent TACE (n=84) to 114 tumors or image guided SBRT (n=125) to 173 tumors. Propensity score analysis with inverse probability of treatment weighting was used to compare outcomes between treatments while adjusting for imbalances in treatment assignment. Local control (LC), toxicity, and overall survival (OS) were retrospectively analyzed.

RESULTS:

The TACE and SBRT groups were similar with respect to the number of tumors treated per patient, underlying liver disease, and baseline liver function. Patients treated with SBRT were older (65 vs 61 years, P=.01), had smaller tumors (2.3 vs 2.9 cm, P<.001), and less frequently underwent liver transplantation (8% vs 18%, P=.01). The 1- and 2-year LC favored SBRT: 97% and 91%, respectively, for SBRT and 47% and 23% for TACE (hazard ratio 66.5, P<.001). For patients treated with TACE, higher alpha-fetoprotein (hazard ratio 1.11 per doubling, P=.008) and segmental portal vein thrombosis (hazard ratio 9.9, P<.001) were associated with worse LC. Predictors associated with LC after SBRT were not identified. Grade 3+ toxicity occurred after 13% and 8% of TACE and SBRT treatments, respectively (P=.05). There was no difference in OS between patients treated with TACE or SBRT.

CONCLUSIONS:

Stereotactic body radiation therapy is a safe alternative to TACE for 1 to 2 tumors and provides better LC, with no observed difference in OS. Prospective comparative trials of TACE and SBRT are warranted.

PMID:
29066120
PMCID:
PMC5818982
DOI:
10.1016/j.ijrobp.2017.09.001
[Indexed for MEDLINE]
Free PMC Article

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