Stereotactic body radiation therapy versus radiofrequency ablation for single small hepatocellular carcinoma: a propensity-score matching analysis of their impact on liver function and clinical outcomes

Masayuki Ueno; Hiroyuki Takabatake; Satoshi Itasaka; Takahisa Kayahara; Youichi Morimoto; Hiroshi Yamamoto; Motowo Mizuno

doi:10.21037/jgo-21-356

Stereotactic body radiation therapy versus radiofrequency ablation for single small hepatocellular carcinoma: a propensity-score matching analysis of their impact on liver function and clinical outcomes

J Gastrointest Oncol. 2021 Oct;12(5):2334-2344. doi: 10.21037/jgo-21-356.

Authors

Masayuki Ueno^{1

2}, Hiroyuki Takabatake¹, Satoshi Itasaka³, Takahisa Kayahara¹, Youichi Morimoto¹, Hiroshi Yamamoto¹, Motowo Mizuno¹

Affiliations

¹ Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Okayama, Japan.
² Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
³ Department of Radiation Oncology, Kurashiki Central Hospital, Okayama, Japan.

Abstract

Background: Stereotactic body radiation therapy (SBRT) has high efficacy for early-stage hepatocellular carcinoma (HCC) and is an accepted alternative to radiofrequency ablation (RFA). However, SBRT for HCC may cause subacute liver injury leading to negative clinical outcomes. In this study, we compared changes of liver function and prognosis after SBRT or RFA in patients with single, small HCC by using a propensity-score matching analysis.

Methods: We reviewed medical records of 140 patients with single ≤3 cm HCC treated with SBRT or RFA at Kurashiki Central Hospital between January 2014 and February 2019. Changes of albumin-bilirubin (ALBI) score, local recurrence, and overall survival were compared between the propensity-score matched groups (31 patients treated with SBRT and 62 treated with RFA).

Results: The ALBI score increased modestly but significantly after SBRT, while it was unchanged in the RFA group; the intergroup difference was statistically significant (P=0.004). No local recurrence was identified in the SBRT group, whereas the cumulative recurrence incidence was 9.7% in the RFA group (P=0.023). Overall survival was not significantly different between the two groups (hazard ratio: 1.32, 95% confidence interval: 0.60-2.89, P=0.401).

Conclusions: SBRT had modestly negative impact on liver function but with appraisable local control of HCC. Our findings should contribute to the selection of this modality for treatment of single, small HCC.

Keywords: Hepatocellular carcinoma (HCC); liver function; propensity-scores; radiofrequency ablation (RFA); stereotactic body radiation therapy (SBRT).