Table 2.
Comparison of SBRT with Radiofrequency Ablation (RFA) or Trans-Arterial Chemoembolization (TACE) in HCC
| Author | Year | Number of Subjects (SBRT/RFA or TACE) | Dose (SBRT) | Study Design | Control Rates (SBRT/RFA) | Overall Survival | Comments |
|---|---|---|---|---|---|---|---|
| Kim et al51 | 2020 | 72 proton therapy/72 RFA | 66 GyE/10# | Prospective Phase 3 randomised controlled trial- (Non-inferiority design) | 2-year LPFS rate 95% (proton therapy)/84% (RFA) (90% CI 1.8–20.0; p <0.001) | 2-year OS rates 92% (proton therapy)/91% (RFA) | First phase III randomized controlled trial of proton beam radiotherapy vs RFA in patients with recurrent small HCC |
| Kim et al50 | 2020 | 496 SBRT/1568 RFA | Median EQD2 (a/b of 10) 72 Gy (IQR 66–88 Gy); median BED10 86 Gy (IQR 79–106 Gy). | Retrospective with propensity score matching | 3-yr cumulative local recurrence rate-21%/28%, (p <0.001) | 2-year Mortality Rate: 26% vs 19%, (p <0.001), before propensity matching | SBRT associated with superior LC in small tumors (≤3 cm) irrespective of location, large tumors located in the subphrenic region, and those that progressed after TACE |
| Su et al55 | 2020 | 167 (SBRT)/159 (TACE); 95/95 for PSM analysis | 28–50 Gy/1-5# | Retrospective propensity matched analysis | 3-yr/5-yr LC= 63%/57% (SBRT) vs 53%/37% (TACE) (p=0.0047) | 3-yr OS= 65% vs 61% (p=0.29) | BCLC Stage A inoperable HCC; Cyberknife; On MVA, treatment (SBRT vs TACE) was a significant covariate associated with local and intrahepatic control (HR = 1.6; 95% CI: 1.03–2.47; P = 0.04; HR = 1.6; 95% CI: 1.13–2.29; P = 0.009) |
| Hara et al44 | 2019 | 143 SBRT/231 RFA | 35–40 Gy/5# or 36–45 Gy/12-15# | Retrospective with propensity score matching (106 patients in each group) | Unmatched 3-year LRR= 5% (SBRT) (95% CI, 3–9) vs 13% (RFA), (95% CI, 10–16) (P < 0.01). | Matched 3-yr OS similar (69%; 95% CI, 58–78; and 70%; 95% CI, 59–79, respectively; P = 0.86). | SBRT- excellent LC and comparable OS in patients with well-compensated liver function. |
| Parikh et al43 | 2018 | 32 SBRT/408 RFA | NR | Retrospective secondary analysis of SEER database- propensity score matched MVA | NR | Overall cohort- 3-yr OS significantly worse with SBRT (HR=1.8; 95% CI=1.15–2.82; p=0.01); in matched analysis, no difference in OS (HR=1.28; 95% CI=0.60–2.72; p=0.53) | SEER database study- older patients with higher co-morbidity burden in SBRT cohort; in matched analysis no difference in survival, 90-day hospitalisation and costs of treatment between RFA and SBRT. |
| Sapir et al54 | 2018 | 125 (SBRT)/84 (TACE) | Median BED=100 Gy/3-5# | Retrospective propensity matched analysis | 2-year LC 91% (SBRT), 23% (TACE); The FFLP rates at 2 years were lower for patients after TACE than after SBRT (10.7% vs 26.9%, respectively), significantly favoring SBRT (HR=3.55, 95% CI= 1.94–6.52, P<0.001). | 2-year OS-34.9% (SBRT), 54.9% (TACE); (HR 0.76, P=0.21) | Patients had 1–2 tumours, 7–11.6% patients had segmental portal vein thrombosis; institutional database; treated on LINAC based SBRT |
| Wahl et al42 | 2015 | 63 SBRT/161 RFA | Median doses 30–50 Gy/3-5# (Range 27 Gy-60Gy) | Retrospective institutional registry-based series with propensity score matching | 2-year FFLP= 83.8% (SBRT)/80.2% (RFA) | 2-year OS 46% (SBRT)/53% (RFA). | Increasing tumor size predicted for FFLP in patients treated with RFA (HR- 1.54 per cm; P = 0.006), but not with SBRT (HR, 1.21 per cm; P =0.617). |
Abbreviations: GyE, gray equivalent; Gy, Gray; #-fractions; SBRT, stereotactic body radiotherapy; RFA, radiofrequency ablation; TACE, trans arterial chemoembolization; LINAC, linear accelerator; LPFS, local progression free survival; FFLP, freedom from local progression; EQD2, equivalent dose in 2Gy per fraction; IQR, interquartile range; BED, biologically effective dose; BCLC, Barcelona Clinic Liver Cancer; MVA, multivariate analysis; LRR, local recurrence rate; SEER, Surveillance, Epidemiology and End-Results program; NR, not reported; HR, hazard ratio; CI, confidence interval.