Comparison of Stereotactic Body Radiation Therapy Combined with or without Transcatheter Arterial Chemoembolization for Patients with Small Hepatocellular Carcinoma Ineligible for Resection or Ablation Therapies

Abstract

To compare the efficacy and safety of stereotactic body radiation therapy (SBRT) with or without transcatheter arterial chemoembolization (TACE) for patients with small hepatocellular carcinoma (HCC) who were ineligible for resection or ablation therapies. A total of 150 patients with 185 HCCs (≤3 nodules, Child-Turcotte-Pugh class A or B, and no vascular or extrahepatic metastases) were treated with SBRT. In principle, TACE was combined before SBRT (combination group), but some patients were treated with SBRT alone (SBRT alone group). The prescribed dose of SBRT was 48Gy in four fractions at the isocenter, 40 Gy in four or five fractions at the D95% of the planning target volume. The overall survival (OS), progression-free survival (PFS), local progression free survival (LPFS) and complication rates were retrospectively compared between the groups. Local progression was defined as irradiated tumor growth in dynamic computed tomography follow-up. Tumor responses were assessed according to the modified Response Evaluation Criteria in Solid Tumors. Treatment-related toxicities were evaluated according to the Common Terminology Criteria for Adverse Events version 4.0. Twenty-eight patients and 122 patients were enrolled in the SBRT alone and combination groups, respectively. The median follow-up periods were 16 and 29 months, respectively. The two-year OS, PFS, and LPFS in SBRT alone or combination group were 78.6% and 80.3% (p = 0.6583), 49.0% and 42.9% (p =0.188), 71.4% and 80.8% (p = 0.9661), respectively. The incidence of ≥ Grade 3 toxicities was 17.9 % in SBRT alone group and 18.9 % in combination group (p =0.903). There were no significant difference of survivals and adverse effects for patients with small HCCs who were performed SBRT with or without TACE. SBRT alone may be a good treatment option for patients with small HCC who were ineligible for resection or ablation therapies.