Transarterial radioembolization versus concurrent chemoradiation therapy for locally advanced hepatocellular carcinoma: A propensity score matching analysis

Publication date: Available online 6 June 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Jeong Eun Song, Kyu Sik Jung, Do Young Kim, Kijun Song, Jong Yun Won, Hye Woon Lee, Beom Kyung Kim, Seung Up Kim, Jun Yong Park, Sang Hoon Ahn, Jinsil Seong, Kwang-Hyub Han
PurposeIt is unclear whether the efficacy and safety of concurrent chemoradiation therapy (CCRT) and transarterial radioembolization (TARE) with Yttrium-90 (Y) are comparable, in patients with locally advanced hepatocellular carcinoma (HCC).Methods and MaterialsIn total, 209 treatment-naive patients with Barcelona Clinic Liver Cancer (BCLC) stage B or C who were treated with TARE or CCRT were analyzed. Propensity scores (PS) were calculated and matched at a 1:1 ratio for TARE vs. CCRT using age, tumor size, tumor number, portal vein thrombosis, and BCLC staging. In CCRT, concurrent hepatic arterial infusion chemotherapy with 5-fluorouracil was delivered at a dose of 500 mg/day during the first and last 5 days of radiation therapy (median 45 Gy). Overall survival (OS), freedom from progression (FFP), tumor response, and complication rate were compared between TARE and CCRT groups.ResultsAmong 209 patients, 124 (62 on TARE, 62 on CCRT) were selected upon PS matching. OS (TARE vs. CCRT, 14.0 months vs. 13.2 months, P=0.435) and FFP (6.9 months vs. 7.8 months, P=0.437) were comparable between the two groups. Objective response rates (ORR) at 1 month post-treatment were higher for CCRT than for TARE (46.8% vs. 16.1%, P <0.001), while ORRs at 3 months were significantly higher for TARE than for CCRT (39.3% vs. 21.4%, P=0.04). There was no significant difference in long-term response rates (at 6 months and 1 year) between the two groups. The CCRT group experienced a higher rate of curative resection or liver transplantation after treatment than the TARE group, although the statistical significance was marginal (24.2% vs. 11.3%, P=0.060). Treatment-related complications were less frequent following TARE than CCRT.ConclusionsBoth treatments yielded comparable survival rates and long-term response rates in patients with intermediate- or advanced-stage HCC. The role of these modalities as a bridge to curative therapy requires further investigation.

Teaser

Both transarterial radioembolization (TARE) and concurrent chemoradiation therapy (CCRT) result in comparably good treatment outcomes in locally advanced hepatocellular carcinoma (HCC), but it is unclear if they are of similar efficacy or have similar safety profiles. We compared the effectiveness of these modalities in patients with locally advanced HCC. Treatment outcomes for TARE and CCRT were comparable, but the role of two modalities as bridge to curative therapy requires further investigations.


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