Transarterial radioembolization versus concurrent chemoradiation therapy for locally advanced hepatocellular carcinoma: A propensity score matching analysis
Menée sur 124 patients atteints d'un carcinome hépatocellulaire de stade B ou C (selon les critères de Barcelone), cette étude compare l'efficacité, du point de vue de la réponse tumorale, de la progression de la maladie et de la survie globale, et les complications d'une chimioradiothérapie concomitante et d'une radioembolisation transartérielle par l'yttrium-90
Purpose : It is unclear whether the efficacy and safety of concurrent chemoradiation therapy (CCRT) and transarterial radioembolization (TARE) with Yttrium-90 (Y) are comparable, in patients with locally advanced hepatocellular carcinoma (HCC). Methods and Materials : In total, 209 treatment-naive patients with Barcelona Clinic Liver Cancer (BCLC) stage B or C who were treated with TARE or CCRT were analyzed. Propensity scores (PS) were calculated and matched at a 1:1 ratio for TARE vs. CCRT using age, tumor size, tumor number, portal vein thrombosis, and BCLC staging. In CCRT, concurrent hepatic arterial infusion chemotherapy with 5-fluorouracil was delivered at a dose of 500 mg/day during the first and last 5 days of radiation therapy (median 45 Gy). Overall survival (OS), freedom from progression (FFP), tumor response, and complication rate were compared between TARE and CCRT groups. Results : Among 209 patients, 124 (62 on TARE, 62 on CCRT) were selected upon PS matching. OS (TARE vs. CCRT, 14.0 months vs. 13.2 months, P=0.435) and FFP (6.9 months vs. 7.8 months, P=0.437) were comparable between the two groups. Objective response rates (ORR) at 1 month post-treatment were higher for CCRT than for TARE (46.8% vs. 16.1%, P <0.001), while ORRs at 3 months were significantly higher for TARE than for CCRT (39.3% vs. 21.4%, P=0.04). There was no significant difference in long-term response rates (at 6 months and 1 year) between the two groups. The CCRT group experienced a higher rate of curative resection or liver transplantation after treatment than the TARE group, although the statistical significance was marginal (24.2% vs. 11.3%, P=0.060). Treatment-related complications were less frequent following TARE than CCRT. Conclusions : Both treatments yielded comparable survival rates and long-term response rates in patients with intermediate- or advanced-stage HCC. The role of these modalities as a bridge to curative therapy requires further investigation.