Comparison of Stereotactic Body Radiotherapy and Transarterial Chemoembolization for Unresectable Medium-sized Hepatocellular Carcinoma
Menée à partir de données portant sur 188 patients atteints d'un carcinome hépatocellulaire non résécable de taille comprise entre 3 et 8 cm (durée médiane de suivi : 17,1 mois), cette étude compare, du point de vue du contrôle de la maladie et de la survie globale, l'efficacité d'une chimio-embolisation transartérielle et d'une radiothérapie corporelle stéréotaxique
Purpose : To compare the local control and overall survival between stereotactic body radiation therapy (SBRT) and transarterial chemoembolization (TACE) in medium-sized (3-8 cm) hepatocellular carcinoma (HCC). Methods and Materials : From January 2008 to October 2017, 188 patients with medium sized HCC underwent either TACE (n = 142) or SBRT (n = 46). We adjusted for imbalances in treatment assignment using propensity score matching (PSM). Infield control (IFC) and overall survival (OS) were analyzed retrospectively. Results : The median follow-up time was 17.1 months for all patients, and 26.6 months for surviving patients. The 3-year IFC for the TACE group was 63.0%, versus 73.3% for the SBRT group. Multivariable analysis identified the independent predictors for IFC as treatment modality (SBRT vs. TACE), sex (female vs. male), and recurrence status (recurrence vs. new diagnosis). The 3-year OS for the TACE group was 22.9%, versus 47.4% for the SBRT group. Multivariable analysis identified the independent predictors of OS as number of tumors, treatment modality (SBRT vs. TACE), albumin-bilirubin (ALBI) grade, tumor volume, Eastern Cooperative Oncology Group (ECOG) status, and recurrence status. PSM analysis revealed that the SBRT group had better IFC (3-year IFC of 77.5% vs. 55.6%, p = .007) and OS (3-year OS of 55.0% vs. 13.0%, p < .001) than the TACE group. For recurrent HCC, the SBRT group exhibited superior IFC (3-year IFC of 75% vs. 57.5%, p = .022) and OS (3-year OS of 58.3% vs. 5.9%, p < .001) compared to the TACE group. However, there was no difference in IFC or OS between TACE and SBRT for patients with newly diagnosed HCC. Conclusion : SBRT exhibits better IFC and OS rates than TACE in patients with medium-sized HCC, particularly for recurrent cases, warranting prospective randomized control trials of TACE and SBRT.