2127 - Efficacy of SBRT vs. TACE (+/- TARE/MWA) for Local Control in Hepatocellular Carcinoma

03:00pm - 04:00pm ET

Poster Hall - Exhibit Hall A

Screen: 28

POSTER

Presenter(s)

Lamees El Nihum, MD, MEng - Fox Chase Cancer Center, Philadelphia, PA

H. A. Lemisch¹, J. Krempa¹, V. Dontu¹, A. A. Abbasi¹, L. I. El Nihum², M. Lubas², P. L. Lee³, L. Zhang⁴, C. Miyamoto², J. E. Meyer², and D. Ioffe⁵; ¹Lewis Katz School of Medicine at Temple University, Philadelphia, PA, ²Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, ³Department of Radiation Oncology, Mass General Brigham, Harvard Medical School, Boston, MA, ⁴Biostatistics and Bioinformatics Facility, Fox Chase Cancer Center, Philadelphia, PA, ⁵Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA

Purpose/Objective(s):

Patients with unresectable, non-metastatic hepatocellular carcinoma (HCC) are often treated with liver-directed therapies such as transarterial chemoembolization (TACE), transarterial radioembolization (TARE), microwave ablation (MWA), or stereotactic body radiation therapy (SBRT). We evaluated patients with HCC to compare the efficacy of SBRT to TACE (+/- TARE/MWA) for local disease control (LC).

Materials/Methods:

This is a single institution, retrospective study of patients with HCC who underwent SBRT or TACE (+/- TARE/MWA) to an untreated lesion from 2015-2025. Descriptive statistics were used to summarize patient demographics, disease characteristics, and treatment patterns. The primary endpoint was time to local failure (TLF) per RECIST 1.1. Local failure (LF) was estimated using Kaplan-Meier curves and compared using the log-rank test. Multivariable Cox proportional hazards models were used to adjust for age, gender, race, ECOG performance status, and Barcelona-Clinic Liver Cancer (BCLC) stage.

Results:

68 patients with HCC were identified who underwent SBRT (n = 44) or TACE (n = 24) to a single newly identified lesion in a previously untreated hepatic lobe. Median age of patients treated with SBRT versus TACE was 72 versus 68 years (p = 0.032); otherwise baseline characteristics were similar across groups. SBRT was delivered in 4 or 5 fractions of 600 to 1200 cGy. TACE was performed alone (n = 14) or with concurrent TARE or MWA (n = 10). On univariate analysis, median TLF was significantly longer with SBRT versus TACE (18.33 vs 8.97 months, p = 0.0085). LF occurred in 12/44 (27%) patients receiving SBRT (median follow-up 9.6 months) and 21/24 (88%) patients receiving TACE (median follow-up 34.6 months). At two years, LC rates for SBRT and TACE were 31.7% and 14.0%, respectively. BCLC stage was shown to correlate with median TLF (p = 0.034). On multivariate analysis, TACE was independently associated with significantly higher risk of LF compared to SBRT (HR 2.69 [95% CI 1.22-5.93], p = 0.01).

Conclusion:

SBRT was associated with significantly improved LC of untreated HCC lesions and longer median TLF when compared to TACE (+/- TARE/MWA). Additional data on safety, tolerability, and patient- and disease-specific characteristics will be critical in determining which patients may benefit most from SBRT.