Comparison of Stereotactic Body Radiation Therapy Combined With or Without Transcatheter Arterial Chemoembolization for Patients With Small Hepatocellular Carcinoma Ineligible for Resection or Ablation Therapies

Introduction: To compare the efficacy and safety of stereotactic body radiation therapy with or without transcatheter arterial chemoembolization for patients with small hepatocellular carcinoma who were ineligible for resection or ablation therapies. Methods: A total of 150 patients with 185 hepatocellular carcinoma (<= 3 nodules, Child-Turcotte-Pugh class A or B, and no vascular or extrahepatic metastases) were treated with stereotactic body radiation therapy. In principle, transcatheter arterial chemoembolization was combined before stereotactic body radiation therapy (combination group), but some patients were treated with stereotactic body radiation therapy alone. The prescribed dose of stereotactic body radiation therapy was 48 Gy in 4 fractions at the isocenter and 40 Gy in 4 or 5 fractions at the dose covering 95% of the planning target volume. The overall survival, progression-free survival, local progression free survival, and complication rates were retrospectively compared between the groups. Local progression was defined as irradiated tumor growth in dynamic computed tomography follow-up. Tumor responses were assessed according to the Modified Response Evaluation Criteria in Solid Tumors. Treatment-related toxicities were evaluated according to the Common Terminology Criteria for Adverse Events version 4.0. Results: Twenty-eight and 122 patients were enrolled in the stereotactic body radiation therapy alone and combination groups, respectively. The median follow-up periods were 16 and 29 months, respectively. The 2-year overall, progression-free, and local progression-free survival times in stereotactic body radiation therapy alone and combination groups were 78.6% and 80.3% (P = .6583), 49.0% and 42.9% (P = .188), and 71.4% and 80.8% (P = .9661), respectively. The incidence of >= grade 3 toxicities was 17.9% in stereotactic body radiation therapy alone group and 18.9% in combination group (P = .903). Conclusions: Stereotactic body radiation therapy alone may be a good treatment option for patients with small hepatocellular carcinoma who were ineligible for resection or ablation therapies.