Overall Survival Among Patients With Hepatocellular Carcinoma Treated With External Beam Radiation Therapy: Individual Patient Data Outcomes From a Multinational Cohort.
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Moon Andrew M, Yanagihara Ted K, Dawson Laura A, Yu Jeong Il, Lawrence Theodore S, Kim Tae Hyun, Yan Michael, Iwata Hiromitsu, Nabavizadeh Nima, Apisarnthanarax Smith, Dunne Emma M, Lock Michael I, Chuong Michael D, Chiang Chi Leung, Scorsetti Marta, Katoh Norio, Sioshansi Shirin, Numata Kazushi, Liu Howard Yu-Hao, Iwamoto Hideki, Wakatsuki Masaru, Chen Yixing, Pollom Erqi L, Gkika Eleni, Jabbour Salma K, Munoz-Schuffenegger Pablo, Dutta Debnarayan, Hajj Carla, Ueno Masayuki, Hallemeier Christopher L, Feldman Aharon M, Méndèz Romero Alejandra, Tan Xianming, Molla Meritxell, Tepper Joel E, Torres Ferran, Reig Maria, EBRT Collaboration Group
Аннотация
METHODS: We performed a systematic review of publications that assessed EBRT, met prespecified technical standards for HCC, and reported OS (search date December 15, 2022). Corresponding authors were invited to submit IPD for the study. We performed Kaplan-Meier survival analyses to determine OS and restricted mean survival time (RMST) stratified by Barcelona Clinic Liver Cancer (BCLC) stage and treatment status (ie, treatment-naïve and experienced). We performed random effects Cox proportional hazards modeling to assess clinical characteristics associated with OS.
RESULTS: Data were provided on 4,913 patients treated with EBRT with a median follow-up time of 5.0 years. The median OS was 6.8 years (95% CI, 5.7 to 8.7) for BCLC-0 and 4.6 years (95% CI, 4.1 to 5.1) for BCLC-A. Among treatment-naïve patients, the median OS was not reached (95% CI, 8.6 to not reached) for BCLC-0 and was 5.4 years (95% CI, 4.5 to 6.7) for BCLC-A. In multivariable models, more advanced BCLC stage, higher tumor burden, worse performance status, and Child-Pugh class B or C were associated with a higher risk of mortality. Ablative radiation dose and more recent year of treatment were associated with a reduced risk of death.
CONCLUSION: To our knowledge, this study represents the largest multinational cohort of patients with HCC treated with EBRT. OS outcomes with EBRT for very early- and early-stage HCC appear to be comparable with resection, thermal ablation, and other ablative locoregional therapies. These data support the inclusion of EBRT in the BCLC HCC clinical decision-making process.