Effect of external beam radiation therapy versus transcatheter arterial chemoembolization for non-diffuse hepatocellular carcinoma (≥ 5 cm): a multicenter experience over a ten-year period

Ke Su; Fei Wang; Xueting Li; Hao Chi; Jianwen Zhang; Kun He; Zhaoyang Wang; Lianbin Wen; Yanqiong Song; Jiali Chen; Zhenying Wu; Yi Jiang; Han Li; Tao Gu; Chenjie Wang; Yaqi Li; Mengxiang Liu; Qulian Guo; Ke Xu; Lu Guo; Yunwei Han

doi:10.3389/fimmu.2023.1265959

Effect of external beam radiation therapy versus transcatheter arterial chemoembolization for non-diffuse hepatocellular carcinoma (≥ 5 cm): a multicenter experience over a ten-year period

Front Immunol. 2023 Sep 25:14:1265959. doi: 10.3389/fimmu.2023.1265959. eCollection 2023.

Authors

Ke Su^{1

2}, Fei Wang³, Xueting Li⁴, Hao Chi¹, Jianwen Zhang¹, Kun He⁵, Zhaoyang Wang⁶, Lianbin Wen⁷, Yanqiong Song⁸, Jiali Chen¹, Zhenying Wu¹, Yi Jiang¹, Han Li¹, Tao Gu¹, Chenjie Wang¹, Yaqi Li⁹, Mengxiang Liu¹⁰, Qulian Guo¹¹, Ke Xu¹², Lu Guo¹³, Yunwei Han¹

Affiliations

¹ Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
² Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
³ Department of General Surgery, Luxian People's Hospital, Luzhou, China.
⁴ Department of Oncology, 363 Hospital, Chengdu, China.
⁵ Clinical Research Institute, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
⁶ Department of Medical Imaging, Southwest Medical University, Luzhou, China.
⁷ Department of Geriatric Cardiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China.
⁸ Department of Radiotherapy, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
⁹ School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
¹⁰ School of Humanities and Management, Southwest Medical University, Luzhou, China.
¹¹ Department of Paediatrics, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
¹² Department of Oncology, Chongqing General Hospital, Chongqing, China.
¹³ Department of Ophthalmology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.

Abstract

Background: The optimal local treatment for HCC with tumor diameter ≥ 5 cm is not well established. This research evaluated the effectiveness of external beam radiation therapy (EBRT) versus transcatheter arterial chemoembolization (TACE) for HCC with tumor diameter ≥ 5 cm.

Methods: A total of 1210 HCC patients were enrolled in this study, including 302 and 908 patients that received EBRT and TACE, respectively. Propensity score matching (PSM) was used to identify patient pairs with similar baseline characteristics. Overall survival (OS) was the primary study endpoint.

Results: We identified 428 patients using 1:1 PSM for survival comparison. Compared with the TACE group, the EBRT group had a significantly longer median OS (mOS) before (14.9 vs. 12.3 months, p = 0.0085) and after (16.8 vs. 11.4 months, p = 0.0026) matching. In the subgroup analysis, compared with the TACE group, the EBRT group had a significantly longer mOS for HCC with tumor diameters of 5-7 cm (34.1 vs. 14.3 months, p = 0.04) and 7-10 cm (34.4 vs. 10 months, p = 0.00065), whereas for HCC with tumor diameters ≥ 10 cm, no significant difference in mOS was observed (11.2 vs. 11.2 months, p = 0.83). In addition, the multivariable Cox analysis showed that Child-A, alkaline phosphatase < 125 U/L, and EBRT were independent prognostic indicators for longer survival.

Conclusion: EBRT is more effective than TACE as the primary local treatment for HCC with tumor diameter ≥ 5 cm, especially for HCC with tumor diameter of 5-10 cm.

Keywords: PD-1 inhibitors; external beam radiation therapy; hepatocellular carcinoma; targeted drugs; transcatheter arterial chemoembolization.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Carcinoma, Hepatocellular* / pathology
Chemoembolization, Therapeutic*
Combined Modality Therapy
Humans
Liver Neoplasms* / pathology
Retrospective Studies

Grants and funding

The authors declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by Sichuan Science and Technology Program (2022YFS0622).