Stereotactic Body Radiotherapy and Yttrium-90 in the Treatment of Hepatocellular Carcinoma: A Comparison of Outcomes and Costs

Abstract

<h3>Purpose/Objective(s)</h3> Stereotactic Body Radiotherapy (SBRT) and Yttrium-90 (Y90) are two modalities utilized for non-operative treatment of hepatocellular carcinoma (HCC). Although there is increasing use of these two modalities, data comparing outcomes and cost are limited. Gaining an understanding of treatment outcomes and costs of SBRT and Y90 would help guide decisions made by multidisciplinary tumor boards. We hypothesize that use of SBRT and Y90 will result in similar oncologic outcomes and costs. <h3>Materials/Methods</h3> Patients treated for HCC with SBRT or Y90 Segmentectomy between January 2018 and January 2020 at one institution were retrospectively reviewed. Demographic, treatment, and outcome data were collected. Demographic and treatment specifics were compared between treatment modalities utilizing Chi square tests. Oncologic outcomes were compared utilizing Kaplan Meier analysis. A subset of SBRT and Y90 patients were randomly selected for cost analysis. Common Procedural Terminology and Healthcare Common Procedure Coding System codes were gathered for the patients' treatments using the institution's Clinical Research Database then entered in Medicare's Physician Fee Schedule and Outpatient Prospective Payment System to determine and compare total cost. <h3>Results</h3> Eighty-seven patients were analyzed, 24 treated with SBRT and 63 treated with Y90. Median follow-up was 315 days. There were no differences in age, race, sex, and number of co-morbidities between the treatment cohorts. Patients treated with SBRT were more likely to have received prior liver directed therapy than those treated with Y90 (66.7% SBRT vs 12.7% Y90, <i>P</i> = 0.000011), to have larger tumors (4.52cm vs 2.96cm, <i>P</i> = 0.000879), and have a greater AJCC staging (<i>P</i> = 0.011606). The treatment related toxicity for the entire cohort was 51.7%, with no difference in toxicity between the treatment groups (50.0% for SBRT vs 52.4% for Y90, <i>P</i> = 0.986424). The one-year local control rate was 87%, with no difference between the treatment groups (87% vs 89%, <i>P</i> = 0.76). In both treatment groups, death was more attributable to other causes (62.5% SBRT vs. 53.8% Y90) than disease progression (37.5% SBRT vs. 38.5% Y90). Average total cost of SBRT was $12,885. Physician professional charges were $1,383 and facility charges were $11,502. Average total cost of Y90 was $19,393. Physician professional charges were $2,178, including charges for both Interventional Radiology and Nuclear Medicine, and facility charges were $17,215. <h3>Conclusion</h3> Both SBRT and Y90 appear to be effective treatments in the management of HCC with high rates of local control. Treatment with SBRT, on average, was at a lower cost than Y90. More research is needed to further evaluate the clinical and cost effectiveness in treating non-operable HCC with SBRT and Y90.