Radiofrequency Ablation Versus Stereotactic Body Radiotherapy for Localized Hepatocellular Carcinoma in Nonsurgically Managed Patients: Analysis of the National Cancer Database

Abstract

Purpose Data that guide selection of optimal local ablative therapy for the management localized hepatocellular carcinoma (HCC) are lacking. Because there are limited prospective comparative data for these treatment modalities, we aimed to compare the effectiveness of radiofrequency ablation (RFA) versus stereotactic body radiotherapy (SBRT) by using the National Cancer Database. Methods We conducted an observational study to compare the effectiveness of RFA versus SBRT in nonsurgically managed patients with stage I or II HCC. Overall survival was compared by using propensity score-weighted and propensity score-matched analyses based on patient-, facility-, and tumor-level characteristics. A sensitivity analysis was performed to evaluate the effect of severe fibrosis/cirrhosis. In addition, we performed exploratory analyses to determine the effectiveness of RFA and SBRT in clinically relevant patient subsets. Results Overall, 3,684 (92.6%) and 296 (7.4%) nonsurgically managed patients with stage I or II HCC received RFA or SBRT, respectively. After propensity matching, 5-year overall survival was 29.8% (95% CI, 24.5% to 35.3%) in the RFA group versus 19.3% (95% CI, 13.5% to 25.9%) in the SBRT group ( P < .001). Inverse probability-weighted analysis yielded similar results. The benefit of RFA was consistent across all subgroups examined and was robust to the effects of severe fibrosis/cirrhosis. Conclusion Our study suggests that treatment with RFA yields superior survival compared with SBRT for nonsurgically managed patients with stage I or II HCC. Even though our results are limited by the biases related to the retrospective study design, we believe that, in the absence of a randomized clinical trial, our findings should be considered when recommending local ablative therapy for localized unresectable HCC.

Effectiveness and cost of radiofrequency ablation and stereotactic body radiotherapy for treatment of early‐stage hepatocellular carcinoma: An analysis of SEER‐medicare

“…One and two‐year survival was similar between the two groups, which is consistent with the findings of our analysis . A more recent study using the National Cancer Database of nearly 4000 patients who received RFA and SBRT for HCC showed that RFA patients had a superior 5‐year survival in a propensity‐matched cohort . While the conclusions of this study differ from our findings, there are several reasons this may be the case.…”

Radiotherapy for Hepatocellular Carcinoma Results in Comparable Survival to Radiofrequency Ablation: A Propensity Score Analysis

“…Other studies have also compared the outcomes of RFA and SBRT using PSM . However, these studies had limitations.…”

“…Neither of the previous PSM studies considered liver function . In patients with HCC, unlike most solid tumors, there are two life‐threatening conditions: cancer and cirrhosis .…”

Potential survival benefit of radiofrequency ablation for small solitary intrahepatic cholangiocarcinoma in nonsurgically managed patients: A population‐based analysis

“…For these patients, chemotherapy and/or radiotherapy have been increasingly used over the past decade in the US with only limited survival benefit . In turn, local ablative techniques, such as the RFA have recently demonstrated promising results in localized ICC, especially intermediate (3‐5 cm) and small (<3 cm) ICCs; yet robust evidence regarding the optimal nonsurgical management of patients with ICC is still lacking . The current study was important because we demonstrated that RFA was associated with a 54% lower mortality risk compared with chemo‐ or radio‐therapy among patients with early stage (stage I/II) unresectable ICC.…”