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Local Ablative Strategies Compared for Hepatocellular Carcinoma

01/16/2018

A recent study analyzed the effects of radiofrequency ablation versus stereotactic body radiotherapy in patients with non-surgically managed localized hepatocellular carcinoma, published in the Journal of Clinical Oncology (online January 12, 2018; doi:10.1200/JCO.2017.75.3228).

Limited data exist to help guide the selection of optimal local ablative therapy for the management of hepatocellular carcinoma. Prospective comparative studies are needed to assess the effects of radiofrequency ablation and stereotactic body radiotherapy in the population.

Devalkumar J Rajyaguru, MD, Gundersen Lutheran Medical Foundation (La Crosse, WI), and colleagues conducted a comparative effectiveness study of radiofrequency ablation versus stereotactic body radiotherapy by using the National Cancer Database. A total of 3980 non-surgically managed patients with stage I-II hepatocellular carcinoma were sampled, 3684 of whom (92.6%) received radiofrequency ablation and 296 of whom (7.4%) received stereotactic body radiotherapy. Overall survival (OS) was compared by using propensity score-weighted and propensity score-matched analyses based on patient-, facility-, and tumor-level characteristics.

Researchers also performed a sensitivity analysis to evaluate the effect of severe fibrosis and cirrhosis. Exploratory analyses were conducted to determine the effectiveness of both treatment modalities in clinically relevant patient subsets.

Results of the propensity matching showed that 5-year OS was 29.8% (95% CI, 24.5% to 35.3%) in patients who received radiofrequency ablation versus 19.3% (95% CI, 13.5% to 25.9%) in patients receiving stereotactic body radiotherapy (P < .001).

Additionally, researchers noted that the inverse probability-weighted analysis yielded comparable results. The benefit of radiofrequency was also consistent across all subgroups assessed and was robust to the effects of severe fibrosis and cirrhosis.

Dr Rajyaguru and colleagues concluded that treatment with radiofrequency yields superior survival compared with stereotactic body radiotherapy for non-surgically managed patients with stage I-II localized hepatocellular carcinoma. “Even though our results are limited by the biases related to the retrospective study design, we believe that, in the absence of a randomized clinical trial, our findings should be considered when recommending local ablative therapy for localized unresectable HCC,” they wrote.—Zachary Bessette