Proton Beam Therapy versus Radiofrequency Ablation for Patients with Treatment-Naïve Single Hepatocellular Carcinoma: A Propensity Score Analysis

Yuta Sekino; Ryosuke Tateishi; Nobuyoshi Fukumitsu; Toshiyuki Okumura; Kazushi Maruo; Takashi Iizumi; Haruko Numajiri; Masashi Mizumoto; Tatsuya Minami; Ryo Nakagomi; Masaya Sato; Yoshinari Asaoka; Hayato Nakagawa; Yuki Hayata; Naoto Fujiwara; Shuichiro Shiina; Kazuhiko Koike; Hideyuki Sakurai

doi:10.1159/000528537

Proton Beam Therapy versus Radiofrequency Ablation for Patients with Treatment-Naïve Single Hepatocellular Carcinoma: A Propensity Score Analysis

Liver Cancer. 2022 Dec 6;12(4):297-308. doi: 10.1159/000528537. eCollection 2023 Sep.

Authors

Yuta Sekino¹, Ryosuke Tateishi², Nobuyoshi Fukumitsu³, Toshiyuki Okumura¹, Kazushi Maruo⁴, Takashi Iizumi¹, Haruko Numajiri¹, Masashi Mizumoto¹, Tatsuya Minami², Ryo Nakagomi², Masaya Sato², Yoshinari Asaoka², Hayato Nakagawa², Yuki Hayata², Naoto Fujiwara², Shuichiro Shiina⁵, Kazuhiko Koike², Hideyuki Sakurai¹

Affiliations

¹ Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
² Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
³ Department of Radiation Oncology, Kobe Proton Center, Kobe, Japan.
⁴ Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
⁵ Department of Gastroenterological Imaging and Interventional Oncology, Juntendo University, Tokyo, Japan.

Abstract

Introduction: Proton beam therapy (PBT) is known to be an effective locoregional treatment for hepatocellular carcinoma (HCC). However, few comparative studies in treatment-naïve cases have been reported. The aim of this study was to compare the survival outcomes of PBT with those of radiofrequency ablation (RFA) in patients with treatment-naïve solitary HCC.

Methods: Ninety-five consecutive patients with treatment-naïve HCC, a single nodule measuring ≤5 cm in diameter, and a Child-Pugh score of ≤8 who were treated with PBT at the University of Tsukuba Hospital between 2001 and 2013 were enrolled in the study. In addition, 836 patients with treatment-naïve HCC treated by RFA at the University of Tokyo Hospital during the same period were analyzed as controls. Recurrence-free survival (RFS) and overall survival (OS) were compared in 83 patient pairs after propensity score matching.

Results: The 1-year, 3-year, and 5-year RFS rates were 86.6%, 49.5%, and 35.5%, respectively, in the PBT group and 59.5%, 34.0%, and 20.9% in the RFA group (p = 0.058); the respective OS rates were 97.6%, 77.8%, and 57.1% in the PBT group and 95.1%, 81.7%, and 67.7% in the RFA group (p = 0.16). Regarding adverse effects, no grade 3 or higher adverse events were noted in the PBT; however, two grade 3 adverse events occurred within 30 days of RFA in the RFA group: one hemoperitoneum and one hemothorax.

Discussion: After propensity score matching, PBT showed no significant difference in RFS and OS compared to RFA. PBT can be an alternative for patients with solitary treatment-naïve HCC.

Keywords: Liver cancer; Percutaneous radiofrequency ablation; Propensity score matching; Proton beam radiotherapy; Survival analysis.

Grants and funding

This research was supported by AMED under grant number JP18ck0106210 and the Health, Labour and Welfare Policy Research Grants from the Ministry of Health, Labour, and Welfare of Japan (Policy Research for Hepatitis Measures [H30-Kansei-Shitei-003]).