Stereotactic Body Radiation Therapy as an Alternative to Transarterial Chemoembolization for Hepatocellular Carcinoma

Sapir, Eli; Tao, Yuansheng; Schipper, Matthew J.; Bazzi, Latifa; Novelli, Paula M.; Devlin, Pauline; Owen, Dawn; Cuneo, Kyle C.; Lawrence, Theodore S.; Parikh, Neehar D.; Feng, Mary

doi:10.1016/j.ijrobp.2017.09.001

Cited by 154 publications

(98 citation statements)

References 39 publications

(34 reference statements)

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“…SBRT does not seem to compromise the measured survival outcomes after TACE. Sapir et al (23) also reported that 209 patients with 287 HCC tumors, and 28 of these cases with portal vein branch thrombosis (BCLC-C), were treated with TACE (n = 84) or SBRT (n = 125) in western countries, where hepatitis C virus (70%) and alcohol abuse (20%) were the main cause of HCC. It was also found that SBRT can be an alternative to TACE for local HCC with one to two tumors and provided better LC, with no difference in OS.…”

Section: Discussionmentioning

confidence: 99%

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

Liang

Zhou

et al. 2020

Front. Oncol.

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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). Su et al. SBRT vs. TACE in HCC 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.

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Section: Discussionmentioning

confidence: 99%

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

Liang

Zhou

et al. 2020

Front. Oncol.

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“…Similarly, at the University of Michigan, where SBRT may be offered for salvage after TACE/RFA failure or as the remaining liver-directed therapy for patients ineligible for other locoregional control options, SBRT for one to two HCC tumors was associated with local control rates of 97% at 1 year and 91% at 2 years. 62 In contrast, patients receiving TACE for one to two HCC tumors had local control rates of 47% at 1 year and 23% at 2 years. This was despite treatment bias favoring TACE for patients who were transplant candidates and thus had fewer liver-directed treatments.…”

Section: Locally Advanced Unresectable Hccmentioning

confidence: 96%

“…[58][59][60] In contrast, grade 3 or higher toxicities from SBRT to unresectable HCC range from 6 to 27%. 43,44,54,62,63 Notably, despite the lower reported rates of grade 3 or higher toxicity, bowel ulceration is a serious and potentially life-threatening complication of SBRT. Therefore, we stress that treatment at a center with experience in SBRT is of utmost importance.…”

Section: Locally Advanced Unresectable Hccmentioning

confidence: 99%

Radiation Therapy in HCC: What Data Exist and What Data Do We Need to Incorporate into Guidelines?

Feng

2018

Semin Liver Dis

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Hepatocellular carcinoma (HCC) is a complex and diverse disease, with choice of treatment dependent on a patient's disease burden, location of disease, underlying liver function, and performance status. While radiation therapy (RT) was historically omitted from treatment algorithms, immense technological advances over the past several decades have enabled introduction of RT as an effective and safe treatment option for patients with HCC. Growing prospective and retrospective evidence supports the use of RT, particularly stereotactic body radiotherapy (SBRT), for a wide range of indications in HCC from locally advanced unresectable disease to bridge therapy for liver transplant candidates. SBRT is associated with excellent local control, even for patients refractory to or ineligible for other forms of locoregional therapy. Treatment is well-tolerated and associated with low rates of severe toxicity. Randomized trials are needed to define the role of SBRT in HCC treatment relative to other established locoregional treatments.

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“…The authors concluded that SBRT is a safe alternative to TACE for 1 to 2 tumors. 10 In a multinational retrospective study, investigators used propensity score matching to compare radiofrequency ablation (RFA) (N ¼ 1,607) with one of the largest cohorts of SBRT (N ¼ 497). SBRT tumors were often larger (median 2.8 vs. 1.8 cm, p < 0.001) and were more likely to have received prior liver-directed therapy (2 vs. 0 time, p < 0.001).…”

Section: General Approach To Sbrt For Hccmentioning

confidence: 99%

Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma

Campbell

Smile

Sittenfeld

et al. 2020

Digestive Disease Interventions

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Primary liver cancer is the seventh most common cancer worldwide and is the second leading cause of cancer-related death. Hepatocellular carcinoma (HCC) accounts for three-quarters of primary liver cancers and less than a third of patients present with curable disease. Liver-directed therapy is essential for the treatment of patients with unresectable HCC and the advancement of stereotactic body radiation therapy (SBRT) has made radiation a safe and effective treatment option in a range of clinical presentations. In this review, we discuss the technical aspects of SBRT and the general approach to treatment of HCC. We explore the use of SBRT for bridging to transplant, downstaging, and the treatment of large tumors and portal vein tumor thrombus. Although there is limited high-quality randomized data, we review the evidence comparing SBRT with other liver-directed therapies and explore areas for future investigation.

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Stereotactic Body Radiation Therapy as an Alternative to Transarterial Chemoembolization for Hepatocellular Carcinoma

Abstract: Stereotactic body radiation therapy is a safe alternative to TACE for 1 to 2 tumors and provides better LC, with no observed difference in OS. Prospective comparative trials of TACE and SBRT are warranted.

Cited by 154 publications

References 39 publications

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

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

Radiation Therapy in HCC: What Data Exist and What Data Do We Need to Incorporate into Guidelines?

Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma

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