Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 28, 2015; 21(48): 13490-13499
Published online Dec 28, 2015. doi: 10.3748/wjg.v21.i48.13490
Comparison of percutaneous radiofrequency ablation and CyberKnife® for initial solitary hepatocellular carcinoma: A pilot study
Kazue Shiozawa, Manabu Watanabe, Takashi Ikehara, Yasushi Matsukiyo, Michio Kogame, Yui Kishimoto, Yusuke Okubo, Hiroyuki Makino, Nobuhiro Tsukamoto, Yoshinori Igarashi, Yasukiyo Sumino
Kazue Shiozawa, Manabu Watanabe, Takashi Ikehara, Yasushi Matsukiyo, Michio Kogame, Yoshinori Igarashi, Yasukiyo Sumino, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Medical Center, Omori Hospital 6-11-1, Omorinishi, Ota-ku, Tokyo 143-8541, Japan
Yui Kishimoto, Yusuke Okubo, Hiroyuki Makino, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa 230-0012, Japan
Nobuhiro Tsukamoto, Department of Radiology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Kanagawa 230-0012, Japan
Author contributions: Shiozawa K, Watanabe M and Igarashi Y designed the study; Ikehara T, Matsukiyo Y and Kogame M performed percutaneous radiofrequency ablation; Kishimoto Y, Okubo Y, Makino H and Tsukamoto N performed CyberKnife® therapy; Shiozawa K and Watanabe M analyzed the data and wrote the manuscript; Sumino Y supervised the study; all authors have read and approved the final version to be published.
Institutional review board statement: The study was approved by the Ethical Review Board of Toho University Medical Center, Omori Hospital.
Informed consent statement: Informed consent was obtained from all patients for being included in the study.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Manabu Watanabe, MD, PhD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Medical Center, Omori Hospital 6-11-1, Omorinishi, Ota-ku, Tokyo 143-8541, Japan. manabu62@med.toho-u.ac.jp
Telephone: +81-3-37624151 Fax: +81-3-37638542
Received: July 5, 2015
Peer-review started: July 7, 2015
First decision: August 2, 2015
Revised: August 16, 2015
Accepted: November 19, 2015
Article in press: November 19, 2015
Published online: December 28, 2015
Processing time: 171 Days and 20.2 Hours
Abstract

AIM: To compare therapeutic outcomes and adverse events in initial solitary hepatocellular carcinoma (HCC) treated with radiofrequency ablation (RFA) and CyberKnife®.

METHODS: Seventy three consecutive patients with initial solitary HCC treated with RFA (38 patients; RFA group) and CyberKnife® (35 patients; CK group) were enrolled in this study. Background factors were compared between the two groups. Local and intrahepatic distant recurrence control, and cumulative survival rates were compared between the two groups. These were determined using the Kaplan-Meier method, and the significance of differences was analyzed by log-rank test. The presence of more grade 3 on CTCAE ver. 4.0 early and late adverse events was investigated.

RESULTS: In background factors, age was significantly higher (P = 0.005) and the tumor diameter was significantly larger (P = 0.001) in the CK group. The 1-year local recurrence control rates were 97.4% and 97.1% in the RFA and CK groups, respectively (P = 0.71); the 1-year intrahepatic distant recurrence control rates were 85.6% and 86.1%, respectively (P = 0.91); and the 1-year cumulative survival rates were 100% and 95.2%, respectively (P = 0.075), showing no significant difference in any rate between the two groups. There were no late adverse event in the RFA group, but 11.4% in the CK group had late adverse events. In the CK group, the Child-Pugh score at 12 mo after treatment was significantly higher than that in the RFA group (P = 0.003) and significantly higher than the score before treatment (P = 0.034).

CONCLUSION: The occurrence of adverse events is a concern, but CyberKnife® treatment is likely to become an important option for local treatment of early HCC.

Keywords: Hepatocellular carcinoma, Radiofrequency ablation, Stereotactic body radiotherapy, CyberKnife®, Adverse event

Core tip: To compare therapeutic outcomes and adverse events in initial solitary hepatocellular carcinoma (HCC) treated with radiofrequency ablation (RFA; 38 patients) or CyberKnife® (35 patients). The 1-year local recurrence control, the 1-year intrahepatic distant recurrence control and the 1-year cumulative survival rates were no significant difference in any rate between the two groups. In the CyberKnife® group, the Child-Pugh score at 12 mo after treatment was significantly higher than that in the RFA group and significantly higher than the score before treatment. The occurrence of adverse events is a concern, but CyberKnife® is likely to become an important option for local treatment of early HCC.