Is SBRT Better Than Ablation for Small Liver Cancer?

TOPLINE:

In patients with recurrent small hepatocellular carcinoma (HCC), stereotactic body radiotherapy (SBRT) demonstrated superior local progression-free survival (PFS) and tumor control at 3 years compared with radiofrequency ablation, particularly in tumors 2 cm or smaller. However, both treatments led to similar overall survival and safety outcomes at 3 years.

METHODOLOGY:

• For patients with small HCC, studies suggest that SBRT may have comparable oncologic outcomes to radiofrequency ablation, but a direct comparison in a randomized trial has not been performed.
• Researchers evaluated 166 patients with recurrent small HCC who were randomly assigned to receive either SBRT (n = 83) or radiofrequency ablation (n = 83) between August 2019 and April 2022 at the Sun Yat-sen University Cancer Center in Guangzhou, China.
• The primary endpoint was local PFS, and secondary endpoints were PFS, overall survival, local control, and safety.
• The median follow-up duration was 42.8 months in the SBRT group and 42.9 months in the radiofrequency ablation group.

TAKEAWAY:

• Compared with patients who received radiofrequency ablation, those who received SBRT showed superior local PFS (hazard ratio [HR], 0.45; P = .014), which was more pronounced for tumors 2 cm or smaller (HR, 0.39; P = .02) vs those between 2 cm and 5 cm (HR, 0.58; P = .31). The cumulative 3-year local PFS rates were 84.3% with SBRT and 67.3% with radiofrequency ablation.
• Local control rates at 3 years were also notably higher with SBRT — 92.8% vs 75.9% (odds ratio [OR], 0.25). Although the median PFS time was longer for patients who received SBRT (37.6 vs 27.6 months), the difference was not statistically significant (HR, 0.76; 95% CI, 0.50-1.15). The 3-year PFS rates were 51.2% with SBRT and 39.7% with radiofrequency ablation.
• Overall survival at 3 years was similar between the two groups — 90.3% for those receiving SBRT and 91.0% for those receiving radiofrequency ablation (HR, 0.91; 95% CI, 0.37-2.22).
• The incidence of both acute and late adverse events was also similar across SBRT and radiofrequency ablation groups (57.8% vs 67.5% for acute, respectively, and 37.3% vs 31.3% for late, respectively), with most events categorized as grade 1 or 2 in severity.

IN PRACTICE:

This randomized controlled trial demonstrated that SBRT provides better local PFS and local tumor control than radiofrequency ablation in treating solitary recurrent small HCC, especially in HCC of 2 cm or smaller, whereas PFS, overall survival, and safety were comparable between the two treatments, the authors concluded.

SOURCE:

The study, co-led by Mian Xi, Zhoutian Yang, Li Hu, Yizhen Fu, and Dandan Hu, from Sun Yat-sen University Cancer Center, Guangzhou, China, was published online in Journal of Clinical Oncology.

LIMITATIONS:

The study predominantly enrolled patients with hepatitis B virus-related HCC, potentially affecting generalizability of the study findings to other HCC etiologies. Additionally, while treatment responses were evaluated by two experienced radiologists, the lack of evaluation conducted by a central review committee and the single-center design may have introduced selection bias and limited patient coverage.

DISCLOSURES:

The study received support from the “5010 program” of the Sun Yat-sen University and the National Natural Science Foundation of China. No potential conflicts of interest were reported.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.