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

Benoît Allignet (1, 2) , Pierre Pradat (3) , Françoise Mornex (4, 5) , Floriane Izarn (4, 5) , Agnès Rode (6, 4) , Jean-Yves Mabrut (3, 7) , Kayvan Mohkam (3, 7) , Philippe Merle (8, 7)

1 Centre Léon Bérard [Lyon]
2 CREATIS - Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé
3 Hôpital de la Croix-Rousse [CHU - HCL]
4 UCBL - Université Claude Bernard Lyon 1
5 CHLS - Centre Hospitalier Lyon Sud [CHU - HCL]
6 Service de Radiologie [Hôpital de la Croix-Rousse - HCL]
7 UNICANCER/CRCL - Centre de Recherche en Cancérologie de Lyon
8 Service d'Hépatologie et de Gastroentérologie [Lyon]

Aims: Transarterial chemoembolization (TACE) is the gold-standard treatment in intermediate hepatocellular carcinoma (HCC), but long-term disease control remains low. Herein, we compared results of TACE followed by hypofractionated radiotherapy (TACE-hRT) to surgical resection (SR) in early single or paucinodular intra-hepatic 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 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 (IQR 54-54), 3 Gy fractions. Median OS follow-up was 93 months. TTP did not significantly differ with 1-year rates of 68.2% and 82.6% (p=0.17) between patients following SR and TACE-hRT, respectively. In contrast, PFS and OS were lower in TACE-hRT group (p=0.015 and p=0.006) with a median OS time being 37 vs 63 months for patients having surgery vs 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 who are merely fit for surgery, TACE-hRT can be an effective and safe treatment. However, surgical management remains the standard of care whenever possible.

Keywords: Hepatocellular carcinoma; transarterial chemoembolization; hypofractionated radiotherapy; SBRT; surgical resection; propensity score

Domains: Cancer; Nuclear medicine; Surgery; Hépatology and Gastroenterology; Santé publique et épidémiologie

Benoît Allignet, Pierre Pradat, Françoise Mornex, Floriane Izarn, Agnès Rode, et al.. Surgical resection versus transarterial chemoembolization followed by moderately hypofractionated radiotherapy in hepatocellular carcinoma. Strahlentherapie und Onkologie, 2023, 199 (3), pp.293-303. ⟨10.1007/s00066-022-02022-0⟩. ⟨hal-04156031⟩