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Abstract

PURPOSE:

It is unclear whether the efficacy and safety of concurrent chemoradiation therapy (CCRT) and transarterial radioembolization (TARE) with 90Y are comparable in patients with locally advanced hepatocellular carcinoma.

METHODS AND MATERIALS:

In total, 209 treatment-naive patients with stage B or C cancer according to the Barcelona Clinic Liver Cancer classification who were treated with TARE or CCRT were analyzed. Propensity scores were calculated and matched at a 1:1 ratio for TARE versus CCRT using age, tumor size, tumor number, portal vein thrombosis, and Barcelona Clinic Liver Cancer staging. In the CCRT group, concurrent hepatic arterial infusion chemotherapy with 5-fluorouracil was delivered at a dosage of 500 mg/d during the first and last 5 days of radiation therapy (median, 45 Gy). Overall survival, freedom from progression, tumor response, and complication rate were compared between the TARE and CCRT groups.

RESULTS:

Among 209 patients, 124 (62 undergoing TARE and 62 undergoing CCRT) were selected after propensity score matching. Overall survival (TARE vs CCRT, 14.0 months vs 13.2 months, P=.435) and freedom from progression (6.9 months vs 7.8 months, P=.437) were comparable between the 2 groups. Objective response rates at 1 month after treatment were higher for CCRT than for TARE (46.8% vs 16.1%, P<.001), while objective response rates at 3 months were significantly higher for TARE than for CCRT (39.3% vs 21.4%, P=.04). There was no significant difference in long-term response rates (at 6 months and 1 year) between the 2 groups. The CCRT group experienced a higher rate of curative resection or liver transplantation after treatment than the TARE group, although the statistical significance was marginal (24.2% vs 11.3%, P=.060). Treatment-related complications were less frequent after TARE than after CCRT.

CONCLUSIONS:

Both treatments yielded comparable survival rates and long-term response rates in patients with intermediate- or advanced-stage hepatocellular carcinoma. The role of these modalities as a bridge to curative therapy requires further investigation.​

Author information​

Song JE1, Jung KS1, Kim DY2, Song K3, Won JY4, Lee HW1, Kim BK1, Kim SU1, Park JY1, Ahn SH1, Seong J5, Han KH1.

1 Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.

2 Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address: dyk1025@yuhs.ac.

3 Department of Biostatistics, Yonsei University College of Medicine, Seoul, Republic of Korea.

4 Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea.

5 Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea.