1 Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
2 Berta-Ottenstein Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
3 Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, United Kingdom.
4 Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center, Milan, Italy.
5 Department of Translational Medicine, Università degli Studi del Piemonte Orientale "A. Avogadro,", Novara, Italy.
6 Department of Gastroenterology and Hepatology, Kindai University School of Medicine, Osakasayama, Japan.
7 Center for Liver Cancer, National Cancer Center Hospital, Goyang, Republic of Korea.
8 Department of Radiation Oncology, Friedrich-Schiller University Jena, Jena, Germany.
9 Radiotherapy Distler, Bautzen, Germany.
10 Department of Radiation Oncology, University Hospital of Cologne, Cologne, Germany.
11 Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany.
12 Department of Radiation Oncology, Ludwig-Maximilians-University Munich, Munich, Germany.
13 Department of Radiation Oncology, University Hospital of Zurich, Zurich, Switzerland.
14 Institute of Innovative Radiotherapy, Department of Radiation Science, Helmholtz Zentrum Munich, Munich, Germany.
15 Department of Radiation Oncology, Klinikum Rechts der Isar, TU Munich, Munich, Germany.
16 Department of Radiation Oncology, Martin Luther University Halle Wittenberg, Halle an der Saale, Germany.
17 Department of Radiation Oncology, University Hospital of Würzburg, Würzburg, Germany.
18 Department of Radiation Oncology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
19 German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany.
20 German Cancer Research Center (DKFZ), Heidelberg, Germany.
21 Department of Radiotherapy, University of Magdeburg, Magdeburg, Germany.
BACKGROUND AND AIMS:
Stereotactic body radiation therapy (SBRT) has emerged as a safe and effective treatment for patients with hepatocellular carcinoma (HCC), but its role in patients with advanced HCC is not yet defined. In this study, we aim to assess the efficacy and safety of SBRT in comparison to sorafenib treatment in patients with advanced HCC.
We included 901 patients treated with sorafenib at six tertiary centers in Europe and Asia and 122 patients treated with SBRT from 13 centers in Germany and Switzerland. Medical records were reviewed including laboratory parameters, treatment characteristics and development of adverse events. Propensity score matching was performed to adjust for differences in baseline characteristics. The primary endpoint was overall survival (OS) and progression-free survival.
Median OS of SBRT patients was 18.1 (10.3-25.9) months compared to 8.8 (8.2-9.5) in sorafenib patients. After adjusting for different baseline characteristics, the survival benefit for patients treated with SBRT was still preserved with a median OS of 17.0 (10.8-23.2) months compared to 9.6 (8.6-10.7) months in sorafenib patients. SBRT treatment of intrahepatic lesions in patients with extrahepatic metastases was also associated with improved OS compared to patients treated with sorafenib in the same setting (17.0 vs. 10.0 months, p = 0.012), whereas in patients with portal vein thrombosis there was no survival benefit in patients with SBRT.
In this retrospective comparative study, SBRT showed superior efficacy in HCC patients compared to patients treated with sorafenib.