Limited data are available on the effect of SBRT in patients with HCC within Milan. We aimed to compare TACE followed by SBRT with TACE alone as initial treatment in patients with HCC within Milan ineligible for liver transplantation or radiofrequency ablation.

Methods-SBRT-TACE group was compared to TACE only for the end-points (i) Complete response (CR) based on the modified RECIST criteria (ii) Overall survival (OS) (iii) Disease-free survival (DFS). Kaplan-Meier survival analysis was performed to determine the 1-, 3-, and 5-year OS and DFS.

Results-We included 50 patients with 61 lesions. Mean age 61.3±9.3 years; 37(74%) were males; 49(98%) had cirrhosis, (CTP class A in 40(81.6%), class B in 9(18.4%)). Forty (80%) patients had single HCC lesion, 9(18%) had 2 lesions, and 1(2%) had 3 lesions. Mean tumor diameter was 2.2±0.9 cm. Median pre-treatment AFP was 8.6 (range: 1.4-785) ng/ml. TACE followed by SBRT was performed in 20 patients; TACE alone in 30 patients. There was no statistically significant difference in the baseline characteristics between the two groups for age, MELD score, CTP score, number and size of HCC lesions, total tumor diameter, total tumor volume, or AFP. CR was achieved in 19(95%) of 20 patients who received SBRT-TACE, and 18(63%) of 30 patients with TACE only (p<0.01). At a mean follow up of 26.3±17.6 months, 15 (30%) patients died. OS at 1-, 3- and 5- year in SBRT-TACE group versus TACE-only group was 90% and 95.8%, 79.1% and 63.3%, 79.1% and 31.6% respectively (Figure 1). OS for SBRT-TACE was clinically significant over TACE-only group but did not achieve statistical significance (p=0.2) likely due to small sample size. DFS at 1-, 3- and 5- year in SBRT- TACE group versus TACE-only group was 90% and 92.6%, 45.6% and 36%, 22.8% and 10.3% respectively (p=0.29).

Conclusions-SBRT plus TACE is associated with a significantly higher complete response rate and a trend towards higher overall survival as compared to TACE alone in patients with HCC within Milan. Large cohort studies are needed to confirm our findings.

CITATION INFORMATION: Murali A., Soota K., Karwal M., Tanaka T., Dunkelberg J., Voigt M. Utility of Combining Stereotactic Body Radiation Therapy (SBRT) to Transarterial Chemoembolization as Destination Therapy for Hepatocellular Cancer (HCC) within Milan Criteria Am J Transplant. 2017;17 (suppl 3).

« Back to 2018 American Transplant Congress