Lenvatinib in combination with radiotherapy versus lenvatinib with transarterial chemoembolization for advanced hepatocellular carcinoma.

BACKGROUND

This study aimed to evaluate the efficacy of lenvatinib combined with either radiotherapy (RT) or transarterial chemoembolization (TACE) in patients with advanced hepatocellular carcinoma (HCC).

METHODS

Conducted between December 2018 and January 2022, this retrospective study included 32 patients with advanced HCC from a single institution. The patients were divided into two treatment groups: RT plus lenvatinib (n = 17) and TACE plus lenvatinib (n = 15). The primary outcomes assessed were overall survival (OS) and infield control (IFC). Treatment modalities, patient demographics, disease characteristics, and therapeutic responses were analyzed using the Kaplan-Meier method and Cox regression models to identify predictors of OS and IFC. To address baseline imbalances and competing risks, inverse-probability-of-treatment weighting (IPTW) and Fine-Gray analyses were applied to better estimate IFC outcomes.

RESULTS

With a median follow-up of 10.2 months, no significant difference in OS was observed between the RT and TACE groups. However, the Kaplan-Meier analysis indicated significantly longer IFC durations in the RT group (p = 0.010), with a 1-year IFC rate of 74.7% compared to 13.2% in the TACE group. Multivariable analysis further demonstrated that the RT group was associated with better IFC outcomes (p = 0.023). After IPTW adjustment, the RT group retained a significant IFC benefit (p = 0.020). At 12 months, the cumulative infield failure rate was 61.0% in the TACE group versus 14.9% in the RT group (p = 0.015). Alpha-fetoprotein levels significantly declined within 3 months after RT (p = 0.002) but not after TACE (p = 0.510). A ≥ 2-point deterioration in the Child-Pugh score was observed in 5.9% of the RT group when compared to 26.7% of the TACE group (p = 0.161).

CONCLUSION

These findings suggest that RT combined with lenvatinib may offer advantages in local tumor control and potentially liver function preservation, providing a promising alternative for patients with advanced HCC.