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Surgical resection versus transarterial chemoembolization followed by moderately hypofractionated radiotherapy in hepatocellular carcinoma

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Abstract

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 54 Gy (interquartile range [IQR] 54–54) in 3‑Gy fractions. Median OS follow-up was 93 months. TTP did not significantly differ between patients following SR and TACE-hRT, with 1‑year rates of 68.2% and 82.6% (p = 0.17), respectively. In contrast, PFS and OS were lower in the TACE-hRT group (p = 0.015 and p = 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 grade ≥ 3 adverse events were presented by 42 (42.9%) SR and 19 (30.6%) TACE-hRT patients (p = 0.17).

Conclusion

In patients presenting Child–Pugh A BCLC‑A 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.

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Acknowledgements

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Funding

No funds, grants, or other support was received for conducting this study.

Author information

Authors and Affiliations

  1. Department of Radiotherapy, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, Auvergne-Rhône-Alpes, France

    Benoît Allignet MD & Françoise Mornex

  2. CREATIS, CNRS UMR 5220, Inserm U1206, INSA-Lyon, Université Jean Monnet Saint-Étienne, Université Claude Bernard Lyon 1, 69621, Villeurbanne, France

    Benoît Allignet MD

  3. Clinical Research Center, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, Lyon, France

    Pierre Pradat

  4. Department of Medical Oncology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Pierre-Bénite, France

    Floriane Izarn

  5. Department of Radiology, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France

    Agnès Rode

  6. Department of General Surgery and Liver Transplantation, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France

    Jean-Yves Mabrut & Kayvan Mohkam

  7. INSERM 1052/CNRS 5286 Unit, Cancer Research Center of Lyon (CRCL), Université Claude Bernard Lyon 1, Lyon, France

    Jean-Yves Mabrut, Kayvan Mohkam & Philippe Merle

  8. Hepatology Unit, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France

    Philippe Merle

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  1. Benoît Allignet MD
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Contributions

B. Allignet: investigation, methodology, writing—original draft preparation, writing—reviewing and editing. P. Pradat: methodology, data curation, formal analysis, visualization. F. Mornex: conceptualization, resources, writing—reviewing and editing. F. Izarn: data acquisition, writing—reviewing and editing. A. Rode: resources, writing—reviewing and editing. J.-Y. Mabrut: resources, writing—reviewing and editing. K. Mohkam: methodology, resources, supervision, writing—reviewing and editing. P. Merle: conceptualization, methodology, resources, supervision, writing—reviewing and editing, project administration.

Corresponding author

Correspondence to Benoît Allignet MD.

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Conflict of interest

B. Allignet, P. Pradat, F. Mornex, F. Izarn, A. Rode, J.-Y. Mabrut, K. Mohkam, and P. Merle declare that they have no competing interests.

Ethical standards

The study protocol was reviewed and approved by the institutional local ethics committee, approval number 20_249. The study was performed in accordance with the 1975 Helsinki declaration and registered in clinicaltrials.gov (NCT04823715).

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Allignet, B., Pradat, P., Mornex, F. et al. Surgical resection versus transarterial chemoembolization followed by moderately hypofractionated radiotherapy in hepatocellular carcinoma. Strahlenther Onkol 199, 293–303 (2023). https://doi.org/10.1007/s00066-022-02022-0

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