Stereotactic Body Radiation Therapy vs. Radiofrequency Ablation for Single Small Hepatocellular Carcinoma: A Propensity-score Matching Analysis of Their Impact on Liver Function and Clinical Outcomes

Abstract

Background: Stereotactic body radiation therapy (SBRT) has high efficacy for early-stage hepatocellular carcinoma (HCC) and is expected as an accepted alternative to radiofrequency ablation (RFA). However, SBRT for HCC may cause subacute liver injury leading to negative clinical outcomes. In this study, we compared changes of liver function and prognosis after SBRT or RFA in patients with single, small HCC by using a propensity-score matching analysis.Methods: We reviewed medical records of 140 patients with single ≤3 cm HCC treated with SBRT or RFA at Kurashiki Central Hospital between January 2014 and February 2019. Changes of albumin-bilirubin (ALBI) score, local recurrence, and overall survival were compared between the propensity-score matched groups (31 patients treated with SBRT and 62 treated with RFA).Results: The ALBI score increased modestly but significantly after SBRT, while it was unchanged in the RFA group; the intergroup difference was statistically significant (p = 0.004). No local recurrence of tumor was identified in the SBRT group, whereas the cumulative recurrence incidence was 9.7% in the RFA group (p = 0.023). Overall survival was not significantly different between the two groups (hazard ratio 1.32, 95% confidence interval 0.60–2.89, p = 0.401).Conclusions: SBRT had modestly negative impact on liver function but better local control of HCC than did RFA. Although long-term follow-up of liver function is necessary with SBRT treatment especially in patients with impaired liver function, SBRT is a satisfactory alternative to RFA for treatment of single, small HCC.

Comparison of stereotactic body radiotherapy and radiofrequency ablation for hepatocellular carcinoma: Systematic review and meta‐analysis of propensity score studies

“…As for toxicities, the rates of grade 3 or higher toxicities were not significantly different between RFA and SBRT. However, increasing mean ALBI score during 1 year after SBRT (p < 0.001) in the study by Ueno et al 21 and CP score deterioration ≥2 at 3 months in the study HEPATOLOGY RESEARCH by Kim et al 8 were reported. In RFA, no liver tissue damage is generally observed outside of the ablated region.…”

“…was excluded due to a lack of description of matching factors in their abstracts. Ultimately, six PS studies remained, 7 , 8 , 12 , 19 , 21 , 22 and among them, three were PS studies that used BCLC‐factors as a matching factor for PS analysis 7,8,21 …”

“…Ultimately, six PS studies remained, 7,8,12,19,21,22 and among them, three were PS studies that used BCLC-factors as a matching factor for PS analysis. 7,8,21…”

“…The study by Parikh et al 18 was excluded because the author belonged to the same institution as Feng and had a smaller study cohort compared to that in the study by Feng et al The study by Uhlig et al 20 was excluded due to a lack of description of matching factors in their abstracts. Ultimately, six PS studies remained, 7,8,12,19,21,22 and among them, three were PS studies that used BCLC-factors as a matching factor for PS analysis. 7,8,21…”