Overall Survival Among Patients With Hepatocellular Carcinoma Treated With External Beam Radiation Therapy: Individual Patient Data Outcomes From a Multinational Cohort
Abstract
PURPOSE External beam radiation therapy (EBRT) has gained delayed acceptance as a recommended first-line treatment modality for patients with hepatocellular carcinoma (HCC), given limited evidence that it improves overall survival (OS). We analyzed individual patient data (IPD) from an international cohort to assess OS among patients with HCC treated with EBRT. 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.
Article Details
Journal Info
Journal of Clinical Oncology
Lippincott Williams & Wilkins
Authors (61)
Andrew M. Moon
Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC
Ted K. Yanagihara
Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
Laura A. Dawson
Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
Jeong Il Yu
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Theodore S. Lawrence
Tae Hyun Kim
Michael Yan
Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
Hiromitsu Iwata
Nima Nabavizadeh
Department of Radiation Medicine, School of Medicine, Oregon Health & Science University, Portland, OR
Smith Apisarnthanarax
Department of Radiation Oncology, University of Washington, Seattle, WA
Emma M. Dunne
Department of Radiation Oncology, British Columbia Cancer—Vancouver, Vancouver, BC, Canada
Michael I. Lock
Department of Radiation Oncology, London Health Sciences Centre, London, ON, Canada
Michael D. Chuong
Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL
Chi Leung Chiang
Department of Clinical Oncology, Centre of Cancer Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong KongChina,
Marta Scorsetti
Department of Biomedical Sciences, Humanitas University, Milan, Italy
Norio Katoh
Shirin Sioshansi
Department of Radiation Oncology, Brown University Health Cancer Institute, Providence, RI
Kazushi Numata
Gastroenterological Center, Yokohama City University Medical Center
Howard Yu-hao Liu
Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, QLD, Australia
Hideki Iwamoto
Masaru Wakatsuki
Yixing Chen
Erqi L. Pollom
Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
Eleni Gkika
Department of Radiation Oncology University Hospital Bonn Bonn Germany
Salma K. Jabbour
Department of Radiation Oncology, Rutgers Cancer Institute, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
Pablo Munoz-Schuffenegger
Radiation Oncology Unit, Department of Hematology—Oncology, Pontificia Universidad Catolica de Chile, Santiago, Chile
Debnarayan Dutta
Department of Radiation Oncology, Radiation Oncology, Amrita Institute of Medical Sciences, Kochi, India
Carla Hajj
Radiation Oncology Department, Cleveland Clinic Abu Dhabi Cancer Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
Masayuki Ueno
Christopher L. Hallemeier
Department of Radiation Oncology, Mayo Clinic, Rochester, MN
Aharon M. Feldman
Department of Radiation Oncology, Henry Ford Health, Detroit, MI
Alejandra Méndèz Romero
Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
Xianming Tan
Meritxell Molla
Radiation Oncology Department, Hospital Clínic Barcelona, Barcelona, Spain
Joel E. Tepper
Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
Ferran Torres
Maria Reig
Alanah M. Bergman
Christopher Crane
Kyle C. Cuneo
Natalie Grindrod
Anca-Ligia Grosu
Rodrigo El Far
Ciro Franzese
Akihiro Funaoka
Marissa Gilbert
Satoshi Itasaka
Sung Uk Lee
Yoo Young Dominique Lee
Joel Mases
Hiroyuki Ogino
Vera Qu
Hee Chul Park
Ramtin Rahmani
Lee Ann Shing
Tomotake Shirono
Teodor Stanescu
Kanokphorn Thonglert
Wilhelm den Toom
Yusuke Uchinami
Zhaochong Zeng