Gastrointestinal Cancer

PD 05 - GI 2 - Poster Discussion

1043 - Combination Therapy With Trans-Arterial Chemoembolization (TACE) With Stereotactic Body Radiation Therapy Versus TACE With Percutaneous Thermal Ablation for Hepatocellular Carcinoma: Which Treatment Strategy is Best?

Monday, October 22
11:27 AM - 11:33 AM
Location: Room 217 A/B

Combination Therapy With Trans-Arterial Chemoembolization (TACE) With Stereotactic Body Radiation Therapy Versus TACE With Percutaneous Thermal Ablation for Hepatocellular Carcinoma: Which Treatment Strategy is Best?
R. Rahmani, Y. Jahangiri, C. Degnin, Y. Tomozawa, Y. Geeratikun, Y. Chen, A. Y. Hung, K. Farsad, and N. Nabavizadeh; Oregon Health and Science University, Portland, OR

Purpose/Objective(s): For hepatocellular carcinoma (HCC), trans-arterial chemoembolization (TACE) has synergistic properties when combined with ablative therapies. We retrospectively compared overall survival (OS) and progression-free survival (PFS) rates of TACE combined with percutaneous thermal ablation (microwave or radiofrequency, T-TA) or TACE combined with stereotactic body radiation therapy (T-SBRT) for patients with HCC at a single institution. Materials/Methods: From 2006 to 2016, HCC patients received T-TA (n=101) or T-SBRT to 50 Gy in 5 fractions (n=83) to a single tumor. Progression-free survival (PFS) per mRECIST and overall survival (OS) were assessed. Patients were censored at time of orthotopic liver transplantation (OLT). Cox proportional hazards models were used to model PFS and OS using covariates. Results: Baseline demographics are presented in Table 1 (CP=Child-Pugh score, ALBI = albumin-bilirubin score, BCLC = Barcelona Clinic Liver Cancer). T-TA had significantly longer overall survival (log-rank p < 0.0001), with one and two-year OS for T-TA vs. T-SBRT of 86% vs. 73% and 72% vs. 43%, respectively. Baseline CP score, ALBI score, BCLC stage and number of prior TACE treatments were all independently associated with OS. After adjusting for significant covariates, patients treated with T-TA had a lower risk of death than those treated with T-SBRT (hazard ratio (HR) 0.39, 95%CI 0.23 – 0.66). T-TA group had significantly better PFS per mRECIST (log-rank p = 0.031), with one and two-year PFS for T-TA vs. T-SBRT of 78% vs. 59% and 60% vs. 44%, respectively. Only baseline BCLC stage and number of prior TACE treatments were independently associated with PFS. After adjustment, patients treated with T-TA did not have a lower risk of progression than those treated with T-SBRT (HR 0.83, 95%CI 0.47 – 1.44). For patients with CP-A liver function and BCLC stage A HCC, one and two-year OS and PFS for T-TA vs. T-SBRT were not statistically different (one and two-year OS: 92% vs. 91% and 81% vs. 69%, respectively, p = 0.075; one and two-year PFS: 84% vs. 69% and 67% vs. 51%, respectively, p=0.26).

Conclusion: In the overall cohort, T-TA showed superior OS but not PFS compared to T-SBRT when adjusted for significant covariates. However, when selecting for patients with the most hepatic reserve and earliest stage HCC (CP-A and BCLC-A), neither OS nor PFS significantly differed. Combination therapy with TACE plus SBRT for early-stage HCC is an effective strategy for patients with preserved liver function. This observed clinical equipoise should be further examined in a randomized trial.
Table 1
T-TA T-SBRT
Male 69 (68.3%) 70 (84.3%)
Female 32 (31.7%) 13 (15.7%)
CP-A 55 (54.5%) 43 (51.8%)
CP-B 44 (43.6%) 34 (41.0%)
CP-C 2 (2.0%) 6 (7.2%)
ALBI 1 15 (14.9%) 17 (20.5%)
ALBI 2 66 (65.3%) 51 (61.4%)
ALBI 3 20 (19.8%) 15 (18.1%)
BCLC-A 92 (91.1%) 58 (69.9%)
BCLC-B 4 (4.0%) 15 (18.1%)
BCLC-C 0 (0%) 4 (4.8%)
BCLC-D 5 (5.0%) 6 (7.2%)
OLT 14 (13.9%) 14 (16.9%)
No OLT 87 (86.1%) 69 (83.1%)
≤ 2 TACE 99 (98.0%) 60 (72.3%)
> 2 TACE 2 (2.0%) 23 (27.7%)

Author Disclosure: R. Rahmani: None. Y. Jahangiri: None. C. Degnin: None. Y. Tomozawa: None. Y. Geeratikun: None. Y. Chen: None. A.Y. Hung: Employee; Providence Sacred Heart Hospital of Spokane. Radiation Oncology Commission Education Committee; American College of Radiology. K. Farsad: Consultant; Cook Medical. Advisor; Bayer. N. Nabavizadeh: None.

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