Thermal ablation compared to stereotactic body radiation therapy for hepatocellular carcinoma: A multicenter retrospective comparative study

Andrew M. Moon, Hannah P. Kim, Amit G. Singal, Dawn Owen, Mishal Mendiratta-Lala, Neehar D. Parikh, Steven C. Rose, Katrina A. McGinty, Chris B. Agala, Lauren M. Burke, Anjelica Abate, Ersan Altun, Christian Beyer, John Do, Michael R. Folkert, Chalon Forbes, Jona A. Hattangadi-Gluth, Paul H. Hayashi, Keri Jones, Gaurav KhatriYuko Kono, Theodore S. Lawrence, Christopher Maurino, David M. Mauro, Charles S. Mayo, Taemee Pak, Preethi Patil, Emily C. Sanders, Daniel R. Simpson, Joel E. Tepper, Diwash Thapa, Ted K. Yanagihara, Kyle Wang, David A. Gerber

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background & Aims: Early-stage HCC can be treated with thermal ablation or stereotactic body radiation therapy (SBRT). We retrospectively compared local progression, mortality, and toxicity among patients with HCC treated with ablation or SBRT in a multicenter, US cohort. Approach & Results: We included adult patients with treatment-naïve HCC lesions without vascular invasion treated with thermal ablation or SBRT per individual physician or institutional preference from January 2012 to December 2018. Outcomes included local progression after a 3-month landmark period assessed at the lesion level and overall survival at the patient level. Inverse probability of treatment weighting was used to account for imbalances in treatment groups. The Cox proportional hazard modeling was used to compare progression and overall survival, and logistic regression was used for toxicity. There were 642 patients with 786 lesions (median size: 2.1 cm) treated with ablation or SBRT. In adjusted analyses, SBRT was associated with a reduced risk of local progression compared to ablation (aHR 0.30, 95% CI: 0.15-0.60). However, SBRT-treated patients had an increased risk of liver dysfunction at 3 months (absolute difference 5.5%, aOR 2.31, 95% CI: 1.13-4.73) and death (aHR 2.04, 95% CI: 1.44-2.88, p < 0.0001). Conclusions: In this multicenter study of patients with HCC, SBRT was associated with a lower risk of local progression compared to thermal ablation but higher all-cause mortality. Survival differences may be attributable to residual confounding, patient selection, or downstream treatments. These retrospective real-world data help guide treatment decisions while demonstrating the need for a prospective clinical trial.

Original languageEnglish (US)
Article numbere00184
JournalHepatology Communications
Volume7
Issue number7
DOIs
StatePublished - Jul 2023

ASJC Scopus subject areas

  • Hepatology

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