Combination Therapy after TACE for Hepatocellular Carcinoma with Macroscopic Vascular Invasion: Stereotactic Body Radiotherapy versus Sorafenib

Lujun Shen, Mian Xi, Lei Zhao, Xuhui Zhang, Xiuchen Wang, Zhimei Huang, Qifeng Chen, Tianqi Zhang, Jingxian Shen, Mengzhong Liu, Jinhua Huang, Lujun Shen, Mian Xi, Lei Zhao, Xuhui Zhang, Xiuchen Wang, Zhimei Huang, Qifeng Chen, Tianqi Zhang, Jingxian Shen, Mengzhong Liu, Jinhua Huang

Abstract

Stereotactic body radiotherapy (SBRT) has shown promising results in the control of macroscopic vascular invasion in patients with hepatocellular carcinoma (HCC); however, its efficacy in comparison to sorafenib when combined with transarterial chemoembolization (TACE) remains to be determined. Between 2009 and 2017, 77 HCC patients with macroscopic vascular invasion receiving TACE⁻SBRT or TACE⁻sorafenib combination therapies were enrolled. The best treatment responses, overall survival (OS), and progression-free survival (PFS) of the two treatment arms were compared. Of the patients enrolled, 26 patients (33.8%) received TACE⁻SBRT treatment, and 51 (66.2%) received TACE⁻sorafenib treatment. The patients in the TACE⁻SBRT group were more frequently classified as elder in age (p = 0.012), having recurrent disease (p = 0.026), and showing lower rates of multiple hepatic lesions (p = 0.005) than patients in TACE⁻sorafenib group. After propensity score matching (PSM), 26 pairs of well-matched HCC patients were selected; patients in the TACE⁻SBRT group showed better overall response rates in trend compared to those in the TACE⁻sorafenib group. The hazard ratio (HR) of OS to PFS for the TACE⁻SBRT approach and the TACE⁻sorafenib approach was 0.36 (95% CI, 0.17⁻0.75; p = 0.007) and 0.35 (95% CI, 0.20⁻0.62; p < 0.001), respectively. For HCC patients with macrovascular invasion, TACE plus SBRT could provide improved OS and PFS compared to TACE⁻sorafenib therapy.

Keywords: hepatocellular carcinoma; macrovascular invasion; sorafenib; stereotactic body radiotherapy; transarterial chemoembolization.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier curves of hepatocellular carcinoma (HCC) patients by different combination therapies in (A) overall survival (OS) before matching; (B) progression-free survival (PFS) before matching; (C) OS after matching; (D) PFS after matching. Note: TACE-S, TACE combined sorafenib therapy; TACE–SBRT, TACE sequentially combined SBRT therapy.
Figure 2
Figure 2
Flowchart of study design. A consecutive series of 746 HCC patients with macroscopic vascular invasion were reviewed and 77 were finally included based on the inclusion and exclusion criteria. Twenty-six patients were selected in each arm after 1:1 PSM.

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