Research ArticleStereotactic body radiation therapy vs. radiofrequency ablation in Asian patients with hepatocellular carcinoma
Graphical abstract
Introduction
Although surgical resection can lead to long-term survival in early-stage HCC, many patients are not appropriate candidates. According to the current guidelines,1,2 several non-surgical, locoregional treatments are available for localized HCC, including stereotactic body radiation therapy (SBRT), radiofrequency ablation (RFA), percutaneous ethanol injection, and transarterial chemoembolization (TACE).
There has been growing evidence to support the efficacy of SBRT, with a 2-year local control rate of 90%.3 In prospective clinical trials, SBRT has demonstrated favorable local control, ranging from 87% to 100% at 1–3 years.[4], [5], [6] However, current guidelines do not recommend SBRT for early-stage HCC; RFA is recommended as the first-line option instead.
Few studies have been conducted to compare the efficacies of SBRT and RFA. Although physicians were intrigued by the results of a recent study comparing SBRT to RFA,7 the efficacy of SBRT remains controversial[8], [9], [10] due to the lack of prospective randomized controlled trials. Herein, we performed a multinational study comparing the effectiveness of SBRT and RFA in patients treated at 7 tertiary-referral hospitals in 5 countries.
Section snippets
Study population
Patients from 7 hospitals (2 in Korea, 2 in Taiwan, 1 in China, 1 in Japan, and 1 in Hong Kong) were included in this study. The diagnosis of HCC was based on either radiological criteria (nodules >2 cm with radiological hallmarks or nodules of 1–2 cm identified using 2 coincidental techniques) or histological review. The inclusion criteria for the entire cohort were as follows: i) histologically or radiologically confirmed HCC; ii) RFA or SBRT with curative intent regardless of prior
Baseline characteristics
Patient and tumor characteristics are listed in Table 1. Among 2,064 patients, 72.2% were male, the median patient age was 64.9 (IQR 57.3–72.8) years, and 21.5% (444/2,064) were diagnosed by histologic review. The most common HCC etiology was chronic HBV infection (61.1%, 1,261/2,064), followed by chronic HCV infection (27.2%, 562/2,064). Most patients presented with well-compensated liver function (Child-Pugh class A, 88.3%). Median tumor size was 2.0 (IQR 1.5–2.8) cm, and 20.6% (425/2,064) of
Discussion
In the current multinational study, we compared a retrospective cohort of 2,064 HCC patients with 2,064 tumors treated with either SBRT or RFA. Although the SBRT group had more unfavorable factors (stage, tumor size, and prior liver-directed treatment) than the RFA group, SBRT provided better local control than RFA in the entire cohort. This was more evident in the matched cohort. Both treatment modalities showed comparable survival rates with tolerable but distinct toxicities.
Several studies
Financial support
This study was supported by the National Nuclear R&D Program through a National Research Foundation of Korea (NRF) grant funded by the Ministry of Science and ICT (Grant number; NRF-2017M2A2A7A02070426) and an Accuray research grant.
Authors' contributions
Study concept and design: J.S.; Acquisition of data: N.K., J.C., J.D.L., Y.L.S., W.Y.H., T.K., V.H.L., Z.C.Z., R.Z., C.S.K., J.Y.W.; Analysis and interpretation of data: N.K., I.J., S.J.H., J.S.; Drafting of the manuscript: N.K., J.S.; Critical revision of the manuscript for important intellectual content: All authors; Statistical analysis: N.K., I.J., S.J.H.; Funding acquirement: J.S.; Administrative, technical, or material support: J.C., J.D.L., Y.L.S., W.Y.H., T.K., V.H.L., Z.C.Z., R.Z.,
Conflict of interest
The authors declare no conflicts of interest that pertain to this work.
Please refer to the accompanying ICMJE disclosure forms for further details.
Acknowledgements
The authors thank Medical Illustration & Design, part of the Medical Research Support Services of Yonsei University College of Medicine, for all artistic support related to this work.
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Author names in bold designate shared co-first authorship