TOPLINE:

In a comparative study, the early addition of radiotherapy to transarterial chemoembolization (TACE) was associated with improved 5-year overall survival and progression-free survival compared with TACE alone among patients with early-stage hepatocellular carcinoma (HCC).

METHODOLOGY:

• For patients with early-stage HCC who are ineligible for standard curative therapies, TACE is a common alternative — but the approach has response rates of only 40%-60%. The addition of radiotherapy may improve patients’ outcomes, but the evidence base is limited.
• To address this gap, researchers conducted a retrospective study of 1243 patients with Barcelona Clinic Liver Cancer stage 0-A single HCC who received first-line treatment at a single institution between 2008 and 2018.
• Overall, 257 patients (median age, 62 years) received TACE plus radiotherapy, and 986 patients (median age, 61 years) received TACE alone. Radiotherapy included stereotactic body radiotherapy at 45 Gy in three consecutive daily fractions (n = 205), and conventional or hypofractionated radiotherapy at 40-50 Gy in 10 daily fractions (n = 52).
• Propensity score matching and subgroup analyses across 14 clinical variables were used to compare overall survival and progression-free survival between the treatment groups and to identify patient subgroups most likely to benefit from combination therapy.

TAKEAWAY:

• Over a median follow-up of 51.9 months, TACE plus radiotherapy vs TACE alone was associated with a greater 5-year overall survival (76.4% vs 62.5%; hazard ratio [HR], 0.64; P < .001) and progression-free survival (41.9% vs 22.3%; HR, 0.58; P < .001). The advantages with combination therapy held among 255 pairs of patients included in the propensity score-matching analysis.
• Early integration of radiotherapy — within 90 days of initial TACE — provided superior outcomes compared with later integration, with 5-year overall survival of 84.3% vs 68.5% (HR, 0.63; P = .035) and progression-free survival of 49.8% vs 33.9% (HR, 0.67; P = .011).
• Subgroup analyses revealed significant interaction effects between combination therapy and tumor size (> 4 cm vs ≤ 4 cm; P = .020), alpha-fetoprotein (AFP) levels (> 100 ng/mL vs ≤ 100 ng/mL; P = .028), and TACE response (noncomplete response vs complete response; P = .047).
• In a stratification model, patients with two or three of those parameters — larger tumor size, elevated AFP levels, or incomplete response to TACE — derived the most benefit from combination therapy: Compared with TACE alone, their overall survival (HR, 0.42; P < .001) and progression-free survival (HR, 0.38; P < .001) were improved with the addition of radiotherapy. Combination therapy also improved outcomes among patients with one of the three parameters, but it did not affect overall survival among patients with none of them.

IN PRACTICE:

These findings, the authors wrote, “demonstrated clear improvements in both [overall survival] and [progression-free survival] with the combined therapy and further revealed that the magnitude of these benefits varied according to tumor size, AFP level, and response to TACE.” Prospective trials are warranted, the authors added, but in the meantime their proposed stratification model “may help identify appropriate candidates for this combined therapy.”

SOURCE:

This study, led by Jinhong Jung, MD, PhD, Asan Medical Center, Seoul, Republic of Korea, was published online in the International Journal of Radiation Oncology, Biology, Physics.

LIMITATIONS:

This study was retrospective and conducted at a single center, which may have introduced selection bias and limited generalizability. Treatment allocation was not randomized, and patients who received radiotherapy more often had a poorer initial response to TACE. Heterogeneity in the number and timing of TACE sessions and in radiotherapy dose fractionation may have influenced outcomes. Treatment-related toxicity was not systematically assessed.

DISCLOSURES:

No funding was received for this study. The authors declared no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.