Stereotactic Body Radiotherapy as an Alternative to Transarterial Chemoembolization for Hepatocellular Carcinoma
Menée à partir de données portant sur 209 patients atteints d'un carcinome hépatocellulaire, cette étude compare l'efficacité, du point de vue du contrôle local de la maladie et de la survie globale, et la toxicité d'une radiothérapie corporelle stéréotaxique guidée par imagerie et d'une chimioembolisation artérielle
Résumé en anglais
Background : There is little data to guide non-surgical treatment selection for patients with HCC. Therefore, we conducted a large, single institutional comparison of transarterial chemoembolization (TACE) and SBRT outcomes in similar groups of patients.
Methods : From 2006 to 2014, 209 patients with 1-2 tumors underwent TACE (n=84) to 114 tumors or image-guided SBRT (n=125) to 173 tumors. Propensity score analysis with inverse probability of treatment weighting was used to compare outcomes between treatments while adjusting for imbalances in treatment assignment. Local control (LC), toxicity, and overall survival (OS) were retrospectively analyzed.
Results : TACE and SBRT groups were similar with respect to the number of tumors treated per patient, underlying liver disease and baseline liver function. Patients treated with SBRT were older (65 vs 61 yrs, p=0.01) and had smaller tumors (2.3 vs 2.9 cm, p < 0.001), and less frequently underwent liver transplantation (8% vs. 18%, p = 0.01). 1- and 2-yr LC favored SBRT: 97% and 91% for SBRT and 47% and 23%, for TACE (HR 66.5, p < 0.001). For patients treated with TACE, higher AFP (HR 1.11 per doubling, p =0.008) and segmental portal vein thrombosis (HR 9.9, p < 0.001) were associated with worse LC. Predictors associated with LC after SBRT were not identified. Grade 3+ toxicity occurred after 13% and 8% of TACE and SBRT treatments, respectively (p = 0.05). There was no difference in OS between patients treated with TACE or SBRT.
Conclusion : SBRT is a safe alternative to TACE for 1-2 tumors, and provides better LC, with no observed difference in OS. Prospective comparative trials of TACE and SBRT are warranted.
