TY - JOUR
T1 - Thermal ablation compared to stereotactic body radiation therapy for hepatocellular carcinoma
T2 - A multicenter retrospective comparative study
AU - Moon, Andrew M.
AU - Kim, Hannah P.
AU - Singal, Amit G.
AU - Owen, Dawn
AU - Mendiratta-Lala, Mishal
AU - Parikh, Neehar D.
AU - Rose, Steven C.
AU - McGinty, Katrina A.
AU - Agala, Chris B.
AU - Burke, Lauren M.
AU - Abate, Anjelica
AU - Altun, Ersan
AU - Beyer, Christian
AU - Do, John
AU - Folkert, Michael R.
AU - Forbes, Chalon
AU - Hattangadi-Gluth, Jona A.
AU - Hayashi, Paul H.
AU - Jones, Keri
AU - Khatri, Gaurav
AU - Kono, Yuko
AU - Lawrence, Theodore S.
AU - Maurino, Christopher
AU - Mauro, David M.
AU - Mayo, Charles S.
AU - Pak, Taemee
AU - Patil, Preethi
AU - Sanders, Emily C.
AU - Simpson, Daniel R.
AU - Tepper, Joel E.
AU - Thapa, Diwash
AU - Yanagihara, Ted K.
AU - Wang, Kyle
AU - Gerber, David A.
N1 - Publisher Copyright:
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Study of Liver Diseases.
PY - 2023/7
Y1 - 2023/7
N2 - 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.
AB - 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.
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U2 - 10.1097/HC9.0000000000000184
DO - 10.1097/HC9.0000000000000184
M3 - Article
C2 - 37314737
AN - SCOPUS:85171899183
SN - 2471-254X
VL - 7
JO - Hepatology Communications
JF - Hepatology Communications
IS - 7
M1 - e00184
ER -