Surgical resection versus transarterial chemoembolization followed by moderately hypofractionated radiotherapy in hepatocellular carcinoma.
Strahlenther Onkol
; 199(3): 293-303, 2023 03.
Article
en En
| MEDLINE
| ID: mdl-36441171
BACKGROUND AND OBJECTIVE: Transarterial chemoembolization (TACE) is the gold standard treatment in intermediate hepatocellular carcinoma (HCC), but long-term disease control rates remain low. Herein, we compared results of TACE followed by hypofractionated radiotherapy (TACE-hRT) to surgical resection (SR) in early single or paucinodular intrahepatic HCC. METHODS: Between June 2004 and November 2016, data on 160 consecutive patients with Barcelona Clinic Liver Cancer (BCLC) stage A Child-Pugh A HCC treated with SR or TACE-hRT in our expert center were retrospectively reviewed. Time to progression (TTP), progression-free survival (PFS), and overall survival (OS) were evaluated. Clinical outcomes were compared using the stabilized-weights inverse probability of treatment weighting propensity score. RESULTS: Ninety-eight patients underwent SR and 62 were treated by TACE-hRT. Median total dose of RT was 54â¯Gy (interquartile range [IQR] 54-54) in 3Gy fractions. Median OS follow-up was 93 months. TTP did not significantly differ between patients following SR and TACE-hRT, with 1year rates of 68.2% and 82.6% (pâ¯= 0.17), respectively. In contrast, PFS and OS were lower in the TACE-hRT group (pâ¯= 0.015 and pâ¯= 0.006), with a median OS of 37 vs. 63 months for patients with surgery and TACE-hRT, respectively. In multivariate analysis, a significant negative impact on PFS and OS was seen for age at diagnosis, on TTP for alcohol-related liver disease, and on OS for total number of HCC nodules. Symptomatic gradeâ¯≥ 3 adverse events were presented by 42 (42.9%) SR and 19 (30.6%) TACE-hRT patients (pâ¯= 0.17). CONCLUSION: In patients presenting Child-Pugh A BCLCA HCC with high risk for surgical complications, TACE-hRT can be an effective and safe treatment. However, surgical management remains the standard of care whenever possible.
Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Quimioembolización Terapéutica
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Carcinoma Hepatocelular
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Neoplasias Hepáticas
Límite:
Humans
Idioma:
En
Revista:
Strahlenther Onkol
Asunto de la revista:
NEOPLASIAS
/
RADIOTERAPIA
Año:
2023
Tipo del documento:
Article
País de afiliación:
Francia