RFA, SBRT Both Good Options for Unresectable Hepatocellular Carcinoma

Both radiofrequency ablation (RFA) and stereotactic body radiotherapy (SBRT) are effective in the treatment of inoperable, non-metastatic hepatocellular carcinoma (HCC), according to a new retrospective trial.

“SBRT is an emerging non-invasive alternative to RFA, with similar local control rates,” wrote study authors led by Mary Feng, MD, of the University of Michigan Medical Center in Ann Arbor. “Although patients with localized HCC who do not undergo surgery are typically candidates for both SBRT and RFA, there are no data comparing these modalities.”

The trial retrospectively examined outcomes of 161 non-metastatic HCC patients undergoing RFA (249 total tumors treated) and 63 patients undergoing SBRT (83 tumors treated). There were several baseline differences between the groups, including lower Child-Pugh scores (P = .003) in the SBRT group and higher alpha-fetoprotein levels in the SBRT patients. The results of the trial were published in the Journal of Clinical Oncology.

The 1-year freedom from local progression (FFLP) was 83.6% with RFA and 97.4% with SBRT. At 2 years, these rates were 80.2% and 83.8%, respectively. On univariate analysis treatment with RFA was associated with local progression, with a hazard ratio (HR) for RFA vs SBRT of 2.63 (P = .016). This held true on a multivariate analysis as well, with an HR of 3.84 (P = .002). Increasing tumor size predicted failure with RFA, but not with SBRT.

The overall survival (OS) rates were not significantly different between groups. At 1 year, the OS was 69.6% with RFA and 74.1% with SBRT; at 2 years, the rates were 52.9% and 46.3%, respectively.

There were 18 grade 3 or higher adverse events in the RFA group, representing 11% of total treatments. In the SBRT group, there were 3 such adverse events, representing 5% of treatments. There were two treatment-related deaths in the RFA group, one from hemothorax and one from gastrointestinal bleeding; there were no deaths as a consequence of SBRT.

Though the study showed better FFLP with SBRT than with RFA, the authors wrote that, “It would be incorrect to suggest that all unresectable HCCs be treated with SBRT. RFA provides excellent local control for tumors smaller than 2 cm but has difficulty controlling lesions larger than 3 cm.”

They emphasized the need for a randomized trial comparing SBRT to percutaneous ablation.