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18-12-2024 | Hepatocellular Carcinoma | Hepatobiliary Tumors

Outcomes of Stereotactic Body Radiotherapy Compared with Surgical Resection in Patients with Hepatocellular Carcinoma and Macrovascular Invasion: A Propensity Score-Matched Analysis

Authors: Michael Yan, MD, MPH, Zhihao Li, MD, Marco P. A. W. Claasen, MD, Anna T. Santiago, MSc, Luckshi Rajendran, MD, Pablo Munoz-Schuffenegger, MD, Cameron Lee, BSc, Christian T. J. Magyar, MD, Ian McGilvray, MD, PhD, Chaya Shwaartz, MD, Trevor Reichman, MD, Carol-Anne Moulton, MD, MEd, PhD, Sean Cleary, MD, MSc, MPH, Grainne O’Kane, MD, Arndt Vogel, MD, Robert Grant, MD, PhD, Tae Kyoung Kim, MD, MS, PhD, Catherine Soo-Yee Naidoo, MD, Ali Hosni, MD, MSc, PhD, Aruz Mesci, MD, PhD, Laura A. Dawson, MD, Gonzalo Sapisochin, MD, PhD, MSc

Published in: Annals of Surgical Oncology | Issue 3/2025

Abstract

Introduction

Patients with advanced hepatocellular carcinoma (HCC) and macrovascular invasion (MVI) are recommended to receive systemic therapy according to guidelines. Stereotactic body radiotherapy (SBRT) and surgery are increasingly used in this patient population. This study compares outcomes from these local treatments.

Methods

Patients diagnosed with HCC with MVI and treated with surgery or SBRT between 1999 and 2022 were included. Propensity score matching minimized bias from confounders. Overall survival (OS) was analyzed using the Kaplan–Meier method,. and local, regional, and distant recurrences were assessed via competing risk methods. Univariable and multivariable analyses adjusted by the Lasso method evaluated OS predictors.

Results

Among 175 patients, 38 underwent surgery and 137 received SBRT. The median age was 61 years, tumor volume was 158.6 cc, and α-fetoprotein level was 197 IU/mL. Most surgical patients had major resection (74%) via an open approach (97%). The median biologically effective dose (BED) for SBRT was 53.7 Gy. After matching, 35 patients per group had a median OS of 16 months. Local failure was higher in the SBRT group (20%) than in the surgery group (12%) at 1 year (p = 0.028). Distant failure was more frequent in surgery (54%) compared with SBRT (17%) [p = 0.003]. Excluding SBRT patients receiving adjuvant systemic therapy did not change the results. In-hospital mortality was 9% post-surgery and 14% experienced post-SBRT liver impairment.

Conclusion

Both surgery and SBRT offer good long-term OS and control. Surgery provides better local control, while SBRT had lower distant relapse. While SBRT has acceptable toxicity, surgery carries a significant mortality risk.

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Title: Outcomes of Stereotactic Body Radiotherapy Compared with Surgical Resection in Patients with Hepatocellular Carcinoma and Macrovascular Invasion: A Propensity Score-Matched Analysis
Authors: Michael Yan, MD, MPH
Zhihao Li, MD
Marco P. A. W. Claasen, MD
Anna T. Santiago, MSc
Luckshi Rajendran, MD
Pablo Munoz-Schuffenegger, MD
Cameron Lee, BSc
Christian T. J. Magyar, MD
Ian McGilvray, MD, PhD
Chaya Shwaartz, MD
Trevor Reichman, MD
Carol-Anne Moulton, MD, MEd, PhD
Sean Cleary, MD, MSc, MPH
Grainne O’Kane, MD
Arndt Vogel, MD
Robert Grant, MD, PhD
Tae Kyoung Kim, MD, MS, PhD
Catherine Soo-Yee Naidoo, MD
Ali Hosni, MD, MSc, PhD
Aruz Mesci, MD, PhD
Laura A. Dawson, MD
Gonzalo Sapisochin, MD, PhD, MSc
Publication date: 18-12-2024
Publisher: Springer International Publishing
Keywords: Hepatocellular Carcinoma
Hepatocellular Carcinoma
Radiotherapy
Systemic Therapy
Systemic Therapy
Published in: Annals of Surgical Oncology / Issue 3/2025
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-024-16456-6

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Outcomes of Stereotactic Body Radiotherapy Compared with Surgical Resection in Patients with Hepatocellular Carcinoma and Macrovascular Invasion: A Propensity Score-Matched Analysis

Abstract

Introduction

Methods

Results

Conclusion

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