Stereotactic body radiation therapy vs. radiofrequency ablation in Asian patients with hepatocellular carcinoma

Nalee Kim, Jason Cheng, Inkyung Jung, Ja Der Liang, Yu Lueng Shih, Wen Yen Huang, Tomoki Kimura, Victor H.F. Lee, Zhao Chong Zeng, Ren Zhenggan, Chul Seung Kay, Seok Jae Heo, Jong Yoon Won, Jinsil Seong

Research output: Contribution to journalArticlepeer-review

68 Citations (Scopus)


Background & Aims: Few studies have been conducted to compare the efficacies of stereotactic body radiation therapy (SBRT) and radiofrequency ablation (RFA). Thus, in this multinational study, we compared the effectiveness of SBRT and RFA in patients with unresectable HCC. Methods: The retrospective study cohort included 2,064 patients treated in 7 hospitals: 1,568 and 496 in the RFA and SBRT groups, respectively. More than half of the patients (56.5%) developed recurrent tumors, mainly after transarterial chemoembolization (44.8%). Propensity score matching was performed to adjust for clinical factors (n = 313 in each group). Results: At baseline, the SBRT group had unfavorable clinical features compared to the RFA group, including BCLC stage (B-C 65% vs. 16%), tumor size (median 3.0 cm vs. 1.9 cm), and frequent history of liver-directed treatment (81% vs. 49%, all p <0.001). With a median follow-up of 27.7 months, the 3-year cumulative local recurrence rates in the SBRT and RFA groups were 21.2% and 27.9%, respectively (p <0.001). After adjusting for clinical factors, SBRT was related to a significantly lower risk of local recurrence than RFA in both the entire (hazard ratio [HR] 0.45, p <0.001) and matched (HR 0.36, p <0.001) cohorts. In subgroup analysis, SBRT was associated with superior local control in small tumors (≤3 cm) irrespective of location, large tumors located in the subphrenic region, and those that progressed after transarterial chemoembolization. Acute grade ≥3 toxicities occurred in 1.6% and 2.6% of the SBRT and RFA patients, respectively (p = 0.268). Conclusions: SBRT could be an effective alternative to RFA for unresectable HCC, particularly for larger tumors (>3 cm) in a subphrenic location and tumors that have progressed after transarterial chemoembolization. Lay summary: It is currently not known what the best treatment option is for patients with unresectable hepatocellular carcinoma. Here, we show that stereotactic body radiation therapy provides better local control than radiofrequency ablation, with comparable toxicities. Stereotactic body radiation therapy appears to be an effective alternative to radiofrequency ablation that should be considered when there is a higher risk of local recurrence or toxicity after radiofrequency ablation.

Original languageEnglish
Pages (from-to)121-129
Number of pages9
JournalJournal of Hepatology
Issue number1
Publication statusPublished - 2020 Jul

Bibliographical note

Funding Information:
This study was supported by the National Nuclear R&D Program through a National Research Foundation of Korea (NRF) grant funded by the Ministry of Science and ICT (Grant number; NRF-2017M2A2A7A02070426 ) and an Accuray research grant.

Publisher Copyright:
© 2020 European Association for the Study of the Liver

All Science Journal Classification (ASJC) codes

  • Hepatology


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