Adjuvant stereotactic body radiotherapy following transarterial chemoembolization in patients with non-resectable hepatocellular carcinoma tumours of ≥ 3 cm

Abstract

Objectives: The optimal locoregional treatment for non-resectable hepatocellular carcinoma (HCC) of ≥ 3 cm in diameter is unclear. Transarterial chemoembolization (TACE) is the initial intervention most commonly performed, but it rarely eradicates HCC. The purpose of this study was to measure survival in HCC patients treated with adjuvant stereotactic body radiotherapy (SBRT) following TACE.

Methods: A retrospective study of patients with HCC of ≥ 3 cm was conducted. Outcomes in patients treated with TACE alone (n = 124) were compared with outcomes in those treated with TACE + SBRT (n = 37).

Results: There were no significant baseline differences between the two groups. The pre-TACE mean number of tumours (P = 0.57), largest tumour size (P = 0.09) and total tumour diameter (P = 0.21) did not differ significantly between the groups. Necrosis of the HCC tumour, measured after the first TACE, did not differ between the groups (P = 0.69). Local recurrence was significantly decreased in the TACE + SBRT group (10.8%) in comparison with the TACE-only group (25.8%) (P = 0.04). After censoring for liver transplantation, overall survival was found to be significantly increased in the TACE + SBRT group compared with the TACE-only group (33 months and 20 months, respectively; P = 0.02).

Conclusions: This retrospective study suggests that in patients with HCC tumours of ≥ 3 cm, treatment with TACE + SBRT provides a survival advantage over treatment with only TACE. Confirmation of this observation requires that the concept be tested in a prospective, randomized clinical trial.

© 2014 International Hepato-Pancreato-Biliary Association.

Figures

Figure 1

Inclusion and exclusion criteria used to select patients for this retrospective study from among 262 patients with hepatocellular carcinoma (HCC) treated with protocols including transarterial chemoembolization (TACE) and stereotactic body radiotherapy (SBRT)

Figure 2

(a) Axial computed tomography (CT) scan demonstrating a hepatocellular carcinoma (HCC) lesion treated with lipiodol-based transarterial chemoembolization (TACE). (b) Axial CT scan obtained 4 months after TACE plus stereotactic body radiotherapy (SBRT) illustrating significant HCC tumour (and surrounding tissue) involution. (c) Axial CT SBRT plan showing highly conformal dose distribution around the target. (d) Coronal CT SBRT plan showing highly conformal dose distribution around the target. (e) Gross pathologic photograph of an HCC specimen obtained at the time of liver transplantation from a patient treated with TACE + SBRT. (f) Histopathology of the HCC specimen in (e) demonstrates complete tumour necrosis and no viable HCC. (Haematoxylin and eosin stain; original magnification ×4)

Figure 3

Kaplan–Meier curves for overall survival in patients with hepatocellular carcinoma tumours of ≥3 cm treated with transarterial chemoembolization (TACE) alone or TACE plus stereotactic body radiotherapy (SBRT) (Wilcoxon test, P = 0.02)