Comparison of stereotactic body radiotherapy following transcatheter arterial chemoembolization vs transcatheter arterial chemoembolization alone in hepatocellular carcinoma

Abstract

BACKGROUND

For patients with unresectable hepatocellular carcinoma (HCC), both stereotactic body radiation therapy (SBRT) and transcatheter arterial chemoembolization (TACE) have demonstrated effectiveness in controlling local tumor growth. We investigated whether combining these treatments could provide better outcomes than TACE monotherapy.

AIM

To evaluate whether combining SBRT with TACE provides superior clinical outcomes compared to TACE alone in patients with unresectable HCC.

METHODS

We conducted a randomized study involving eighty patients diagnosed with unresectable HCC, classified as Barcelona Clinic Liver Cancer stage B and Child-Pugh class A. Participants were divided into two treatment arms: A control group receiving TACE alone (Group A) and an experimental group receiving sequential TACE and SBRT (Group B). The SBRT regimen consisted of 40 Gy administered in five daily fractions over one week. Primary endpoints included local control, progression-free survival (PFS), and overall survival (OS), with secondary endpoints focusing on toxicity profiles. Additional analyses explored the impact of different SBRT dose levels.

RESULTS

The study enrolled 88 patients from April 2021 to January 2023, with 48 assigned to Group A and 40 to Group B. Over a median follow-up period of 20 months, the combination therapy group demonstrated superior outcomes in both tumor control and disease progression metrics. Complete response rates reached 75% in Group B compared to 54.5% in Group A. The combination therapy extended median PFS to 16 months, significantly longer than the 11 months observed with TACE alone (P = 0.003). Neither group had reached median OS by study conclusion. Importantly, both treatment approaches showed comparable safety profiles.

CONCLUSION

Our findings suggest that supplementing TACE with SBRT offers a well-tolerated and effective treatment strategy for advanced HCC patients. This combination approach achieved better tumor control and delayed disease progression compared to TACE monotherapy, while maintaining an acceptable safety profile.

Keywords: Stereotactic body radiation therapy; Transcatheter arterial chemoembolization; Hepatocellular carcinoma; Radiation-induced liver disease; Progression-free survival; Toxicity

Core Tip: Combining transcatheter arterial chemoembolization (TACE) and stereotactic body radiation therapy (SBRT) significantly enhanced local tumor control and prolonged progression-free survival in unresectable hepatocellular carcinoma. Despite a mild increase in hepatic toxicity, it remained manageable and reversible, with most patients recovering by three months. The synergy of TACE’s localized chemotherapy and SBRT’s precise high-dose radiation is a promising approach for Barcelona Clinic Liver Cancer stage B, Child-Pugh A patients. Our findings emphasize careful dosing, robust imaging guidance, and close monitoring of liver function to optimize safety. Integration of immunotherapy and further refinements in treatment planning might yield even better outcomes in the future.