Abstract
ABSTRACT
Background
Stereotactic ablative body radiotherapy (SABR) shows promise as curative therapy for early‐stage hepatocellular carcinoma (HCC). We retrospectively assessed the efficacy of SABR and microwave ablation (MWA) in a multi‐centre Australian cohort, comparing local recurrence (LR), mortality, and toxicity.
Methods
This was a retrospective cohort study of 215 early stage HCC tumours treated with SABR across 4 referral centres. Cohort comparison was made to single centre data of MWA in 121 tumours.
Results
The main aetiologies of liver disease were hepatitis C and alcohol. The SABR cohort had higher prior HCC treatment (70% vs. 48%;
p
2 cm (58% vs. 40%;
p
= 0.002). LR in the SABR cohort were 4.9% and 6.2% at 1 and 2 years respectively. LR rates in the MWA cohort were 12.4% and 17.3% at 1 and 2 years respectively (
p
= 0.006). After adjustment for age, sex, MELD, previous HCC treatment, tumour size, and AFP, the SABR cohort had reduced risk of LR compared to MWA (aHR 0.24; 95% CI 0.1–0.58,
p
= 0.001). Survival was higher in the MWA cohort to the SABR cohort (
p
Conclusion
SABR demonstrated reduced LR compared to MWA in HCC tumours > 2 cm. The worse survival rates in the SABR cohort may reflect patient factors independent of HCC. Our study findings provide further justification for randomised‐controlled trials investigating SABR as primary treatment for early‐stage HCC.