Dual Modality Radiation May Improve Survival in HCC with Gross Vascular Invasion

Patients with hepatocellular carcinoma (HCC) and gross vascular invasion (GVI) may have improved overall survival (OS) after being treated with dual modality radiation with external beam radiation therapy (EBRT) and transarterial radioembolization (TARE). Researchers reported their findings in the American Journal of Clinical Oncology.

Systemic therapy such as sorafenib has had poor outcomes for patients with HCC and GVI, so researchers undertook the study to determine whether there were differences in outcomes using dual modality radiation (EBRT+TARE) compared with EBRT alone in patients with HCC and GVI. The retrospective study took place between 2011 and 2017 and included 45 patients with HCC and GVI who were treated with EBRT±TARE.

Kaplan-Meier method and log-rank test were used to compare progression-free survival (PFS) and OS, and univariable and multivariable Cox proportional hazards regression evaluated the impact of the variables stage, etiology of cirrhosis, Child-Pugh (CP) score, and Karnofsky Performance Score (KPS) on PFS and OS.

Results showed well-balanced patient characteristics, with the exception of KPS and CP score. Patients who were treated with EBRT+TARE had a median OS of 263 days, while those treated with only EBRT had a median OS of 193 days, but these results were not seen on multivariate analysis, the researchers said.

For the 12 patients who had EBRT and TARE delivered within 2 months as planned, median PFS was 218 days for dual modality radiation compared with 63 days for only EBRT. However, when EBRT and TARE treatment occurred within 6 months, there was no longer a difference in PFS, as TARE was given as a salvage therapy for some patients.

“Dual modality radiation may be associated with improved PFS in patients with HCC and GVI compared with EBRT alone when EBRT and TARE are delivered within 2 months of each other as part of a planned dual modality treatment strategy,” the researchers stated. However, they added that a prospective clinical trial is necessary for further validation and to overcome the selection bias of the retrospective study.

Reference

McGee HM, King MJ, Özbek U, et al. Dual modality radiation with external beam radiation therapy and transarterial radioembolization for hepatocellular carcinoma with gross vascular invasion. Am J Clin Oncol. 2019 Feb 6. doi: 10.1097/COC.0000000000000523. [Epub ahead of print]