Can Radiation Segmentectomy Perform Better than TACE for Early HCC?

Patients who underwent radiation segmentectomy had better responses on imaging and greater time to secondary therapy (TTST) than patients who received transarterial chemoembolization (TACE) for treatment of early-stage hepatocellular carcinoma (HCC).

Radiation segmentectomy involves giving lobar doses more selectively, but previous studies comparing radioembolization and chemoembolization have used wide inclusion criteria that might not accurately reflect outcomes for a segmental approach.

In the current study, researchers treated 534 patients with radioembolization and 877 patients with TACE from January 2012 to January 2016. Of those patients, a group of 112 patients who were naïve to locoregional therapy and had solitary HCC ≤ 3 cm without vascular invasion or metastasis was retrospectively identified. The patients were stratified using baseline patient demographics, tumor characteristics, and laboratory values. Next, the researchers conducted propensity score matching using a nearest neighbor algorithm.

Results before propensity score matching showed a complete response rate of 81.2% for radiation segmentectomy and 49.1% for chemoembolization. Patients in the chemoembolization group had a median of 246 days before secondary therapy, while those in the chemoembolization group had a median of 700 days before secondary therapy.

After propensity score matching, there was an overall complete response rate of 92.1% among patients who received radiation segmentectomy, whereas those who received chemoembolization had an overall complete response rate of 52.6%. Also, after propensity score matching took place, the time to secondary treatment was a median of 161 days for chemoembolization vs 812 days for radiation segmentectomy.

Prior to propensity score matching, as well as after matching, there was no significant difference in overall survival between the radiation segmentectomy and chemoembolization groups.

“In conclusion, the present study demonstrates improved imaging response and longer time to secondary therapy for radiation segmentectomy compared with transarterial chemoembolization in the treatment of early stage HCC. Although this did not directly translate into a significant survival benefit, inherent limitations related to treatment crossover, sample size, and follow-up time created an environment in which only a very large difference in survival was likely to be detected,” the researchers stated.

Although prospective, randomized trials are needed, the authors believe that “radiation segmentectomy has the potential to deliver improved imaging outcomes and longer time to secondary therapy relative to transarterial chemoembolization.”

Reference

Biederman DM, Titano JJ, Korff RA, et al. Radiation segmentectomy versus selective chemoembolization in the treatment of early-stage hepatocellular carcinoma. J Vasc Interv Radiol. 2017 Nov 21. pii: S1051-0443(17)30830-8. doi: 10.1016/j.jvir.2017.08.026. [Epub ahead of print].