Radiofrequency ablation versus stereotactic body radiotherapy for localized hepatocellular carcinoma in nonsurgically managed patients: Analysis of the national cancer database

Devalkumar J. Rajyaguru, Andrew J. Borgert, Angela L. Smith, Reggie M. Thomes, Patrick D. Conway, Thorvardur R. Halfdanarson, Mark Truty, A. Nicholas Kurup, Ronald S. Go

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Abstract

Purpose: Data that guide selection of optimal local ablative therapy for the management localized hepato-cellular carcinoma (HCC) are lacking. Because there are limited prospective comparative data for these treatment modalities, we aimed to compare the effectiveness of radiofrequency ablation (RFA) versus stereotactic body radiotherapy (SBRT) by using the National Cancer Database. Methods: We conducted an observational study to compare the effectiveness of RFA versus SBRT in nonsurgically managed patients with stage I or II HCC. Overall survival was compared by using propensity score-weighted and propensity score-matched analyses based on patient-, facility-, and tumor-level characteristics. A sensitivity analysis was performed to evaluate the effect of severe fibrosis/cirrhosis. In addition, we performed exploratory analyses to determine the effectiveness of RFA and SBRT in clinically relevant patient subsets. Results: Overall, 3,684 (92.6%) and 296 (7.4%) nonsurgically managed patients with stage I or II HCC received RFA or SBRT, respectively. After propensity matching, 5-year overall survival was 29.8% (95% CI, 24.5% to 35.3%) in the RFA group versus 19.3% (95% CI, 13.5% to 25.9%) in the SBRT group (P < .001). Inverse probability-weighted analysis yielded similar results. The benefit of RFA was consistent across all subgroups examined and was robust to the effects of severe fibrosis/cirrhosis. Conclusion: Our study suggests that treatment with RFA yields superior survival compared with SBRT for nonsurgically managed patients with stage I or II HCC. Even though our results are limited by the biases related to the retrospective study design, we believe that, in the absence of a randomized clinical trial, our findings should be considered when recommending local ablative therapy for localized unresectable HCC.

Original languageEnglish (US)
Pages (from-to)600-608
Number of pages9
JournalJournal of Clinical Oncology
Volume36
Issue number6
DOIs
StatePublished - Feb 20 2018

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Radiosurgery
Hepatocellular Carcinoma
Databases
Carcinoma
Fibrosis
Neoplasms
Propensity Score
Survival
Therapeutics
Observational Studies
Randomized Controlled Trials
Retrospective Studies

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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Radiofrequency ablation versus stereotactic body radiotherapy for localized hepatocellular carcinoma in nonsurgically managed patients : Analysis of the national cancer database. / Rajyaguru, Devalkumar J.; Borgert, Andrew J.; Smith, Angela L.; Thomes, Reggie M.; Conway, Patrick D.; Halfdanarson, Thorvardur R.; Truty, Mark; Kurup, A. Nicholas; Go, Ronald S.

In: Journal of Clinical Oncology, Vol. 36, No. 6, 20.02.2018, p. 600-608.

Research output: Contribution to journalArticle

Rajyaguru, Devalkumar J. ; Borgert, Andrew J. ; Smith, Angela L. ; Thomes, Reggie M. ; Conway, Patrick D. ; Halfdanarson, Thorvardur R. ; Truty, Mark ; Kurup, A. Nicholas ; Go, Ronald S. / Radiofrequency ablation versus stereotactic body radiotherapy for localized hepatocellular carcinoma in nonsurgically managed patients : Analysis of the national cancer database. In: Journal of Clinical Oncology. 2018 ; Vol. 36, No. 6. pp. 600-608.
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abstract = "Purpose: Data that guide selection of optimal local ablative therapy for the management localized hepato-cellular carcinoma (HCC) are lacking. Because there are limited prospective comparative data for these treatment modalities, we aimed to compare the effectiveness of radiofrequency ablation (RFA) versus stereotactic body radiotherapy (SBRT) by using the National Cancer Database. Methods: We conducted an observational study to compare the effectiveness of RFA versus SBRT in nonsurgically managed patients with stage I or II HCC. Overall survival was compared by using propensity score-weighted and propensity score-matched analyses based on patient-, facility-, and tumor-level characteristics. A sensitivity analysis was performed to evaluate the effect of severe fibrosis/cirrhosis. In addition, we performed exploratory analyses to determine the effectiveness of RFA and SBRT in clinically relevant patient subsets. Results: Overall, 3,684 (92.6{\%}) and 296 (7.4{\%}) nonsurgically managed patients with stage I or II HCC received RFA or SBRT, respectively. After propensity matching, 5-year overall survival was 29.8{\%} (95{\%} CI, 24.5{\%} to 35.3{\%}) in the RFA group versus 19.3{\%} (95{\%} CI, 13.5{\%} to 25.9{\%}) in the SBRT group (P < .001). Inverse probability-weighted analysis yielded similar results. The benefit of RFA was consistent across all subgroups examined and was robust to the effects of severe fibrosis/cirrhosis. Conclusion: Our study suggests that treatment with RFA yields superior survival compared with SBRT for nonsurgically managed patients with stage I or II HCC. Even though our results are limited by the biases related to the retrospective study design, we believe that, in the absence of a randomized clinical trial, our findings should be considered when recommending local ablative therapy for localized unresectable HCC.",
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T1 - Radiofrequency ablation versus stereotactic body radiotherapy for localized hepatocellular carcinoma in nonsurgically managed patients

T2 - Analysis of the national cancer database

AU - Rajyaguru, Devalkumar J.

AU - Borgert, Andrew J.

AU - Smith, Angela L.

AU - Thomes, Reggie M.

AU - Conway, Patrick D.

AU - Halfdanarson, Thorvardur R.

AU - Truty, Mark

AU - Kurup, A. Nicholas

AU - Go, Ronald S.

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N2 - Purpose: Data that guide selection of optimal local ablative therapy for the management localized hepato-cellular carcinoma (HCC) are lacking. Because there are limited prospective comparative data for these treatment modalities, we aimed to compare the effectiveness of radiofrequency ablation (RFA) versus stereotactic body radiotherapy (SBRT) by using the National Cancer Database. Methods: We conducted an observational study to compare the effectiveness of RFA versus SBRT in nonsurgically managed patients with stage I or II HCC. Overall survival was compared by using propensity score-weighted and propensity score-matched analyses based on patient-, facility-, and tumor-level characteristics. A sensitivity analysis was performed to evaluate the effect of severe fibrosis/cirrhosis. In addition, we performed exploratory analyses to determine the effectiveness of RFA and SBRT in clinically relevant patient subsets. Results: Overall, 3,684 (92.6%) and 296 (7.4%) nonsurgically managed patients with stage I or II HCC received RFA or SBRT, respectively. After propensity matching, 5-year overall survival was 29.8% (95% CI, 24.5% to 35.3%) in the RFA group versus 19.3% (95% CI, 13.5% to 25.9%) in the SBRT group (P < .001). Inverse probability-weighted analysis yielded similar results. The benefit of RFA was consistent across all subgroups examined and was robust to the effects of severe fibrosis/cirrhosis. Conclusion: Our study suggests that treatment with RFA yields superior survival compared with SBRT for nonsurgically managed patients with stage I or II HCC. Even though our results are limited by the biases related to the retrospective study design, we believe that, in the absence of a randomized clinical trial, our findings should be considered when recommending local ablative therapy for localized unresectable HCC.

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