PV QA 1 - Poster Viewing Q&A 1
Purpose/Objective(s): Patients with unresectable hepatocellular carcinoma (urHCC) may be treated by a number of local modalities, including stereotactic body radiotherapy (SBRT) and yttrium-90 microsphere radioembolization (Y90). In this observational study we examined trends of utilization between these two treatments and investigated the respective effectiveness of each.
Materials/Methods: The National Cancer Database (NCDB) was queried for patients diagnosed with HCC who were not treated by surgery between the years 2004 – 2015. Patients with T1-T3b tumors, without metastatic disase, who received SBRT or Y90 as upfront therapy were identified. We characterized treatment patterns within these two cohorts based on several demographic factors and T-stage groupings. Survival functions were investigated by use of Kaplan-Meier estimates and log-rank test.
Results: Between 2004—2005 690 patients with urHCC were treated with SBRT and 5,167 patients were treated with Y90. Utilization of Y90 rose from 59 cases in 2004 to 672 cases in 2013, with a median of 215 cases. In 2014 and 2015 1,022 cases and 1,256 cases were reported, respectively. 4 cases of SBRT were reported in 2004, which rose to 105 cases in 2015, with a median of 52 cases during the time period examined. Of those patients treated by SBRT, 79.7% presented with cT1 or cT2 lesions and 8.5% presented with T3a or T3b. In the Y90 group, 54.6% of patients presented with cT1 or cT2 lesions and 27.8% presented with T3a/b lesions. 75.1% of patients treated by SBRT and 79% of patients treated by Y90 presented with significant fibrosis (fibrosis score 5-6). 71% of patients treated by SBRT had lesions less than 5cm, whereas 44.8% of Y90 patients presented with lesions <5cm and 45% presented with lesions >5cm. For early stage urHCC (T1 or T2) 1-year, 2-year, and 3-year survival in those patients treated with upfront SBRT was 74%, 50.2%, and 35.5%, respectively, with median survival of 24.2 months. 1-year, 2-year, and 3-year survival for early stage urHCC patients treated with upfront Y90 was 65.7%, 43.4%, and 30.7%, respectively, with median survival of 20.0 months.
Conclusion: Both SBRT and Y90 are accepted treatment options for patients with urHCC. Based on current treatment patterns, SBRT is considerably less utilized compared to Y90 across all patient sub-types and T-stages. Utilization of Y90 in particular has dramatically increased in recent years. SBRT, when used, tends to be directed towards patients with early stage disease and smaller tumors, whereas Y90 is utilized across patient groups and tumor stages. Survival curves, particularly for early stage urHCC, suggest that both Y90 and SBRT are viable treatment options.
The asset you are trying to access is locked. Please enter your access key to unlock.