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Comparing Thermal Ablation and SBRT for Hepatocellular Carcinoma

By: Amanda E. Ruffino, BA
Posted: Friday, September 8, 2023

Andrew M. Moon, MD, of Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, and colleagues conducted a multicenter retrospective study comparing the efficacy and safety of thermal ablation and stereotactic body radiation therapy (SBRT) in treating early-stage hepatocellular carcinoma. The study, conducted from 2012 to 2018 and published in Hepatology Communications, included adults with treatment-naive hepatocellular carcinoma lesions without vascular invasion. SBRT was found to be linked to a lower risk of local disease progression versus thermal ablation but higher all-cause mortality.

Outcomes assessed were local disease progression after a 3-month landmark period at the lesion level and overall survival at the patient level. Inverse probability of treatment weighting was used to balance the treatment groups, and statistical analyses were performed using Cox proportional hazard modeling for measuring disease progression and overall survival, as well as logistic regression for toxicity.

A total of 642 patients with 786 lesions (median size: 2.1 cm) were treated with either ablation or SBRT. The results showed that SBRT was associated with a reduced risk of local disease progression compared with thermal ablation (adjusted hazard ratio [HR] = 0.30, 95% confidence interval [CI] = 0.15-0.60). However, the study also found some concerning results regarding SBRT. Patients treated with the procedure had an increased risk of liver dysfunction at 3 months (absolute difference = 5.5%, adjusted odds ratio [OR] = 2.31, 95% CI = 1.13-4.73) and an increased risk of death (adjusted HR = 2.04, 95% CI = 1.44-2.88, P < .0001) compared with those treated with thermal ablation.

The authors suggested that the observed survival differences could be attributed to residual confounding factors, patient selection biases, or differences in subsequent treatments received by the patients. They emphasized the need for prospective clinical trials to provide more robust evidence and to better guide treatment decisions.

Disclosure: For full disclosures of the study authors, visit

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