Stereotactic Body Radiation Therapy vs. Transarterial Chemoembolization in Inoperable Barcelona Clinic Liver Cancer Stage a Hepatocellular Carcinoma: A Retrospective, Propensity-Matched Analysis

Ting-Shi Su; Ping Liang; Ying Zhou; Yong Huang; Tao Cheng; Song Qu; Long Chen; Bang-De Xiang; Chang Zhao; De-Jia Huang; Shi-Xiong Liang; Le-Qun Li

doi:10.3389/fonc.2020.00347

Stereotactic Body Radiation Therapy vs. Transarterial Chemoembolization in Inoperable Barcelona Clinic Liver Cancer Stage a Hepatocellular Carcinoma: A Retrospective, Propensity-Matched Analysis

Front Oncol. 2020 Mar 24:10:347. doi: 10.3389/fonc.2020.00347. eCollection 2020.

Authors

Ting-Shi Su¹, Ping Liang², Ying Zhou², Yong Huang², Tao Cheng², Song Qu¹, Long Chen¹, Bang-De Xiang³, Chang Zhao⁴, De-Jia Huang⁴, Shi-Xiong Liang¹, Le-Qun Li³

Affiliations

¹ Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China.
² Department of Radiation Oncology, Rui Kang Hospital, Guangxi Traditional Chinese Medical University, Nanning, China.
³ Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, China.
⁴ Department of Interventional Radiology, Guangxi Medical University Cancer Hospital, Nanning, China.

Abstract

Background and Objective: It is unclear if stereotactic body radiation therapy (SBRT) or transarterial chemoembolization (TACE) is better for the treatment of inoperable early-stage hepatocellular carcinoma (HCC). This study aimed to retrospectively compare the efficacy of SBRT to TACE in patients with inoperable Barcelona Clinic Liver Cancer (BCLC)-A stage HCC. Materials and Methods: In this multi-institutional retrospective study, a total of 326 patients with inoperable BCLC-A stage HCC were enrolled. Totally, 167 patients initially received SBRT and 159 initially received TACE. Overall survival (OS), local control (LC), intrahepatic control (IC), and progression-free survival (PFS) were evaluated in univariable and propensity-score matched analyses. Results: There was a smaller median tumor size in the SBRT group than in the TACE group (3.4 cm vs. 7.2 cm, P < 0.001). After propensity score matching in the selection of 95 patient pairs, SBRT had better LC, IC, and PFS than TACE but showed comparable OS. The accumulative 1-, 3-, and 5-year OS rates were 85.7, 65.1, and 62.8% in the SBRT group and 83.6, 61.0, and 50.4% in the TACE group, respectively (P = 0.29). The accumulative 1-, 3-, and 5-year PFS were 63.4, 35.9, and 27.5% in the SBRT group and 53.5, 27.4, and 14.2% in the TACE group, respectively (P = 0.049). The accumulative 1-, 3-, and 5-year LC were 86.8, 62.5, and 56.9% in the SBRT group and 69.3, 53.3, and 36.6% in the TACE group, respectively (P = 0.0047). The accumulative 1-, 3-, and 5-year IC were 77.3, 45.9, and 42.4% in the SBRT group and 57.3, 34.1, and 17.7% in the TACE group, respectively (P = 0.003). On multivariate analysis, treatment (SBRT vs. TACE) was a significant covariate associated with local and intrahepatic control (HR = 1.59; 95% CI: 1.03-2.47; P = 0.04; HR = 1.61; 95% CI: 1.13-2.29; P = 0.009). Conclusions: SBRT was an alternative to TACE for inoperable BCLC-A stage HCC with better local and intrahepatic control. Controlled clinical trials are recommended to evaluate the actual effects of this novel regimen adequately.

Keywords: Barcelona Clinic Liver Cancer Stage A; SBRT; TACE; hepatocellular carcinoma; overall survival.