Radiotherapy for Hepatocellular Carcinoma Results in Comparable Survival to Radiofrequency Ablation: a Propensity Score Analysis

Abstract

Potentially curative treatments for early‐stage hepatocellular carcinoma (HCC) have each drawbacks and contraindications. Recently, radiotherapy can achieve good outcomes. We compared the outcomes of radiotherapy and radiofrequency ablation (RFA) for early‐stage HCC. Consecutive patients with ≤3 early‐stage HCC lesions and tumor diameters ≤3 cm treated with RFA or radiotherapy were reviewed. RFA was the first choice for HCC unsuitable for surgery. Otherwise, stereotactic body radiotherapy in 5 fractions was mainly performed. For HCC adjacent to gastrointestinal tract, radiotherapy with mild hypofractionation was performed. Propensity score matching was performed to reduce the selection bias between RFA and radiotherapy groups. Between 2012 and 2016, a total of 231 patients with 474 tumors and 143 patients with 221 tumors were eligible and were treated with RFA and radiotherapy, respectively. In an unmatched comparison, the 3‐year local recurrence rate was significantly lower for radiotherapy than for RFA (5.3% [95% CI, 2.7‐9.2] vs. 12.9% [95% CI, 9.9‐16.2]) (p < 0.01). A propensity score matching analysis of 106 patients in each group successfully matched the two treatment groups with regard to Barcelona Clinic Liver Cancer staging, T stage and tumor size, but not the adjacency of the tumor to risk organs or first or salvage treatment. The 3‐year overall survival rates for RFA and radiotherapy patients were comparable (69.1% [95% CI, 58.2‐77.7] and 70.4% [95% CI, 58.5‐79.4], respectively; p = 0.86).

Conclusion

Radiotherapy has excellent local control and comparable OS in patients with well‐compensated liver function, exhibiting advantageous characteristics and compensating for the deficiencies of other treatment modalities. Radiotherapy appears to be an acceptable alternative treatment option for patients that are not candidates for RFA.

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