Comparing Local Ablative Therapies for Localized HCC

Nonsurgically managed patients with stage II or III hepatocellular carcinoma (HCC) who were treated with radiofrequency ablation (RFA) had better survival results than patients treated with stereotactic body radiotherapy (SBRT), researchers reported in the Journal of Clinical Oncology.

The researchers undertook the study because prospective comparative data for local ablative therapies for localized HCC are limited. In this observational study, they used the National Cancer Database to compare the effectiveness of RFA versus SBRT in nonsurgically managed patients with stage I or II HCC. There were 3,684 patients who received RFA and 296 who received SBRT.

Propensity score-weighted and propensity score-matched analyses based on patient-, facility-, and tumor-level characteristics were used to assess overall survival. Additionally, the effect of severe fibrosis/cirrhosis was evaluated through a sensitivity analysis.

Results showed that 5-year survival was 29.8% among patients who received RFA, compared with 19.3% among patients who received SBRT. Similar results were seen following inverse probability-weighted analysis.

“The benefit of RFA was consistent across all subgroups examined and was robust to the effects of severe fibrosis/cirrhosis,” the authors added.

They concluded, “Our study suggests that treatment with RFA yields superior survival compared with SBRT for nonsurgically managed patients with stage I or II HCC. Even though our results are limited by the biases related to the retrospective study design, we believe that, in the absence of a randomized clinical trial, our findings should be considered when recommending local ablative therapy for localized unresectable HCC.”

Reference

Rajyaguru DJ, Borgert AJ, Smith AL, et al. Radiofrequency Ablation Versus Stereotactic Body Radiotherapy for Localized Hepatocellular Carcinoma in Nonsurgically Managed Patients: Analysis of the National Cancer Database. J Clin Oncol. 2018 Jan 12:JCO2017753228. doi: 10.1200/JCO.2017.75.3228. [Epub ahead of print].