Comparison of local tumor control in patients with HCC treated with SBRT or TACE: a propensity score analysis

Bettinger, Dominik; Gkika, Eleni; Schultheiß, Michael; Glaser, Nicolas; Langè, S.; Maruschke, Lars; Buettner, Nico; Kirste, Simon; Nestle, Ursula; Grosu, Anca‐Ligia; Thimme, Robert; Brunner, Thomas

doi:10.1186/s12885-018-4696-8

Cited by 29 publications

(17 citation statements)

References 25 publications

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“…The overall survival at 2 years was 46% versus 53% for SBRT versus RFA, respectively 67. Similarly, after propensity score matching, the LC rate in HCC patients receiving TACE versus SBRT was comparable for local control, overall survival, and 1 year mortality 68…”

Section: Resultsmentioning

confidence: 93%

Role of Radiotherapy in the Treatment of Hepatocellular Carcinoma

Chen¹

2019

Journal of Clinical and Translational Hepatology

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The role of radiotherapy in the treatment of hepatocellular carcinoma (HCC) has evolved over the past few decades with the advancement of technology and improved imaging. Radiotherapy can offer high local control rates in unresectable HCC, including cases with major vascular involvement, and can provide a modality to help bridge patients to potentially curative resection or transplantation. In metastatic cases, radiotherapy can provide good palliation. This review focuses on the common radiotherapy treatment modalities used for HCC, provides outcome comparisons of these radiotherapy techniques to outcomes with other treatment modalities for HCC, and highlights the discrepancy of the role of radiotherapy in HCC amongst the current available treatment guidelines.

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Section: Resultsmentioning

confidence: 93%

Role of Radiotherapy in the Treatment of Hepatocellular Carcinoma

Chen¹

2019

Journal of Clinical and Translational Hepatology

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“…Several, retrospective, studies that used propensity score matching in order to compare both treatments, indicate that SBRT could be an alternative to TACE in terms of local control. Bettinger et al ( 23 ) showed similar local control rates after 1 year (TACE: 82%, SBRT 84.8%, p = 0.8) and OS (TACE: 11 months, SBRT 9 months, p = 0.49) for both treatments, with moderate toxicity, whereas Sapir et al ( 24 ) showed that both LC at 1 year (SBRT 91%, TACE 47%, p < 0.001) and toxicity (TACE: 13%, SBRT: 8%, p = 0.05) favored SBRT, without any difference in the OS. Similarly, in a study by Shen et al ( 25 ) SBRT showed a better in-field control after 3 years (77.5 vs. 55.6%) and OS rates (3-year OS of 55 vs. 13%) than TACE in patients with medium-sized HCC, particularly for recurrent cases.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Stereotactic Body Radiotherapy in Patients With Hepatocellular Carcinoma Not Suitable for Transarterial Chemoembolization (HERACLES: HEpatocellular Carcinoma Stereotactic RAdiotherapy CLinical Efficacy Study)

et al. 2021

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The aim of this prospective observational trial was to evaluate the efficacy, toxicity and quality of life after stereotactic body radiation therapy (SBRT) in patients with hepatocellular carcinoma (HCC) and to assess the results of this treatment in comparison to trans-arterial chemoembolization (TACE). Patients with HCC, treated with TACE or SBRT, over a period of 12 months, enrolled in the study. The primary endpoint was feasibility; secondary endpoints were toxicity, quality of life (QOL), local progression (LP) and overall survival (OS). Between 06/2016 and 06/2017, 19 patients received TACE and 20 SBRT, 2 of whom were excluded due to progression. The median follow-up was 31 months. The QOL remained stable before and after treatment and was comparable in both treatment groups. Five patients developed grade ≥ 3 toxicities in the TACE group and 3 in the SBRT group. The cumulative incidence of LP after 1-, 2- and 3-years was 6, 6, 6% in the SBRT group and 28, 39, and 65% in the TACE group (p = 0.02). The 1- and 2- years OS rates were 84% and 47% in the TACE group and 44% and 39% in the SBRT group (p = 0.20). In conclusion, SBRT is a well-tolerated local treatment with a high local control rates and can be safely delivered, while preserving the QOL of HCC patients.

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“…Multiple studies have shown that SBRT is as effective as local ablation for early stage hepatocellular carcinoma and has similar efficacy to TACE for intermediate stage disease. [103][104][105][106][107] A small, open label, phase II randomized controlled trial showed that SBRT in combination with TACE was superior to sorafenib in improving the survival of patients with advanced stage disease. 108 While SBRT is not currently considered as a first line treatment option for hepatocellular carcinoma, it could be a promising alternative treatment, especially when primary treatment modalities are not feasible.…”

Section: Surgical Resectionmentioning

confidence: 99%

“…It is a highly conformal technique using external beam radiation therapy delivered in high doses to the tumor in a small number of fractions. Multiple studies have shown that SBRT is as effective as local ablation for early stage hepatocellular carcinoma and has similar efficacy to TACE for intermediate stage disease 103104105106107. A small, open label, phase II randomized controlled trial showed that SBRT in combination with TACE was superior to sorafenib in improving the survival of patients with advanced stage disease 108.…”

Section: Treatmentmentioning

confidence: 99%

New advances in the diagnosis and management of hepatocellular carcinoma

Yang

Heimbach

2020

BMJ

276

187

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Hepatocellular carcinoma is one of the leading causes of cancer related death in the world. Biannual surveillance for the disease in patients with cirrhosis and in high risk carriers of hepatitis B virus allows early stage cancer detection and treatment with good long term outcomes. Liver ultrasonography and serum α fetoprotein are the most commonly used surveillance tests. If suspicious results are found on the surveillance test, multiphasic computed tomography or magnetic resonance imaging should be undertaken to confirm the diagnosis of hepatocellular carcinoma. If radiologic tests show inconclusive results, liver biopsy or repeat imaging could be considered for confirmation of hepatocellular carcinoma. Management of the disease is complex. Patients should be evaluated by a multidisciplinary team, and the selection of treatment should consider factors such as tumor burden, severity of liver dysfunction, medical comorbidities, local expertise, and preference of patients. Early stage hepatocellular carcinoma is best managed by curative treatment, which includes resection, ablation, or transplantation. Patients with intermediate stage disease often receive locoregional treatment. Systemic treatment is reserved for patients with advanced disease. Several positive, phase III, randomized controlled trials have expanded the systemic treatment options for advanced hepatocellular carcinoma with promising long term outcomes, especially trials using combination treatments, which could also have eventual implications for the treatment of earlier stage disease.

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Comparison of local tumor control in patients with HCC treated with SBRT or TACE: a propensity score analysis

Cited by 29 publications

References 25 publications

Role of Radiotherapy in the Treatment of Hepatocellular Carcinoma

Role of Radiotherapy in the Treatment of Hepatocellular Carcinoma

Efficacy of Stereotactic Body Radiotherapy in Patients With Hepatocellular Carcinoma Not Suitable for Transarterial Chemoembolization (HERACLES: HEpatocellular Carcinoma Stereotactic RAdiotherapy CLinical Efficacy Study)

New advances in the diagnosis and management of hepatocellular carcinoma

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