TY - JOUR
T1 - Radiation Segmentectomy for the Treatment of Solitary Hepatocellular Carcinoma
T2 - Outcomes Compared with Those of Surgical Resection
AU - De la Garza-Ramos, Cynthia
AU - Montazeri, S. Ali
AU - Croome, Kristopher P.
AU - LeGout, Jordan D.
AU - Sella, David M.
AU - Cleary, Sean
AU - Burns, Justin
AU - Mathur, Amit K.
AU - Overfield, Cameron J.
AU - Frey, Gregory T.
AU - Lewis, Andrew R.
AU - Paz-Fumagalli, Ricardo
AU - Ritchie, Charles A.
AU - McKinney, J. Mark
AU - Mody, Kabir
AU - Patel, Tushar
AU - Devcic, Zlatko
AU - Toskich, Beau B.
N1 - Publisher Copyright:
© 2022 SIR
PY - 2022/7
Y1 - 2022/7
N2 - Purpose: To investigate the outcomes of radiation segmentectomy (RS) versus standard-of-care surgical resection (SR). Materials and Methods: A multisite, retrospective analysis of treatment-naïve patients who underwent either RS or SR was performed. The inclusion criteria were solitary hepatocellular carcinoma ≤8 cm in size, Eastern Cooperative Oncology Cohort performance status of 0–1, and absence of macrovascular invasion or extrahepatic disease. Target tumor and overall progression, time to progression (TTP), and overall survival rates were assessed. Outcomes were censored for liver transplantation. Results: A total of 123 patients were included (RS, 57; SR, 66). Tumor size, Child-Pugh class, albumin-bilirubin score, platelet count, and fibrosis stage were significantly different between cohorts (P ≤.01). Major adverse events (AEs), defined as grade ≥3 per the Clavien-Dindo classification, occurred in 0 patients in the RS cohort vs 13 (20%) patients in the SR cohort (P <.001). Target tumor progression occurred in 3 (5%) patients who underwent RS and 5 (8%) patients who underwent SR. Overall progression occurred in 19 (33%) patients who underwent RS and 21 (32%) patients who underwent SR. The median overall TTP was 21.9 and 29.4 months after RS and SR, respectively (95% confidence interval [CI], 15.5–28.2 and 18.5–40.3, respectively; P =.03). Overall TTP subgroup analyses showed no difference between treatment cohorts with fibrosis stages 3–4 (P =.26) and a platelet count of <150 × 109/L (P =.29). The overall progression hazard ratio for RS versus SR was not significant per the multivariate Cox regression analysis (1.16; 95% CI, 0.51–2.63; P =.71). The median overall survival was not reached for either of the cohorts. Propensity scores were calculated but were too dissimilar for analysis. Conclusions: RS and SR were performed in different patient populations, which limits comparison. RS approached SR outcomes, with a lower incidence of major AEs, in patients who were not eligible for hepatectomy.
AB - Purpose: To investigate the outcomes of radiation segmentectomy (RS) versus standard-of-care surgical resection (SR). Materials and Methods: A multisite, retrospective analysis of treatment-naïve patients who underwent either RS or SR was performed. The inclusion criteria were solitary hepatocellular carcinoma ≤8 cm in size, Eastern Cooperative Oncology Cohort performance status of 0–1, and absence of macrovascular invasion or extrahepatic disease. Target tumor and overall progression, time to progression (TTP), and overall survival rates were assessed. Outcomes were censored for liver transplantation. Results: A total of 123 patients were included (RS, 57; SR, 66). Tumor size, Child-Pugh class, albumin-bilirubin score, platelet count, and fibrosis stage were significantly different between cohorts (P ≤.01). Major adverse events (AEs), defined as grade ≥3 per the Clavien-Dindo classification, occurred in 0 patients in the RS cohort vs 13 (20%) patients in the SR cohort (P <.001). Target tumor progression occurred in 3 (5%) patients who underwent RS and 5 (8%) patients who underwent SR. Overall progression occurred in 19 (33%) patients who underwent RS and 21 (32%) patients who underwent SR. The median overall TTP was 21.9 and 29.4 months after RS and SR, respectively (95% confidence interval [CI], 15.5–28.2 and 18.5–40.3, respectively; P =.03). Overall TTP subgroup analyses showed no difference between treatment cohorts with fibrosis stages 3–4 (P =.26) and a platelet count of <150 × 109/L (P =.29). The overall progression hazard ratio for RS versus SR was not significant per the multivariate Cox regression analysis (1.16; 95% CI, 0.51–2.63; P =.71). The median overall survival was not reached for either of the cohorts. Propensity scores were calculated but were too dissimilar for analysis. Conclusions: RS and SR were performed in different patient populations, which limits comparison. RS approached SR outcomes, with a lower incidence of major AEs, in patients who were not eligible for hepatectomy.
UR - http://www.scopus.com/inward/record.url?scp=85132705556&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85132705556&partnerID=8YFLogxK
U2 - 10.1016/j.jvir.2022.03.021
DO - 10.1016/j.jvir.2022.03.021
M3 - Article
C2 - 35346857
AN - SCOPUS:85132705556
SN - 1051-0443
VL - 33
SP - 775-785.e2
JO - Journal of Vascular and Interventional Radiology
JF - Journal of Vascular and Interventional Radiology
IS - 7
ER -