Long‐Term Survival and Prognostic Factors of Stereotactic Body Radiotherapy Following Transarterial Chemoembolization for Hepatocellular Carcinoma

TL;DR

This study shows that combining two treatments for liver cancer can lead to better long-term survival for patients with large tumors.

Contribution

The study identifies key prognostic factors and confirms the effectiveness of combining TACE and SBRT for HCC.

Findings

Median overall survival was 32.6 months with 1-, 3-, and 5-year survival rates of 73.8%, 24.5%, and 19.6%.

Factors like AFP levels, treatment response, patient age, EQD2, and BED10 were linked to better survival outcomes.

The combination of TACE and SBRT is effective and safe for large HCC tumors.

Abstract

This study presents a detailed analysis of long‐term survival and critical factors influencing the outcomes of hepatocellular carcinoma patients treated with stereotactic body radiotherapy (SBRT) and transarterial chemoembolization (TACE). Our findings provide reassurance about the potential of the combination of TACE and SBRT as an effective treatment strategy for patients with large liver tumors due to HCC.

A prospective study was conducted on 42 patients with intermediate‐stage hepatocellular carcinoma (HCC) at 108 Military Central Hospital between December 2018 and June 2024. Following a single session of TACE, each patient underwent SBRT 1 month later. The SBRT dose ranged from 27.5 to 48 Gy, delivered in 3–5 fractions. The patient survival analysis was conducted using the Kaplan–Meier method while examining prognostic factors influencing survival, which involved log‐rank tests and Cox proportional hazards regression analysis.

Among the 42 patients (83.3% male), 34 patients (81.0%) had tumors measuring ≥ 5 cm. The median follow‐up period was 32.2 months (4.5–65.1 months). The median overall survival (OS) was 32.6 months, with the respective 1‐, 3‐, and 5‐year OS rates reported as 73.8%, 24.5%, and 19.6%. Furthermore, the median progression‐free survival (PFS) was 16.6 months, with corresponding 1‐ and 3‐year PFS rates of 71.4% and 19.0%. Factors linked to improved OS and PFS included AFP levels and treatment response based on Modified RECIST criteria. Additionally, multivariate analysis identified patient age, EQD2, and BED10 as significant predictors of better survival outcomes.

Our study provides evidence supporting the effectiveness and safety of combining TACE and SBRT as a treatment strategy for patients with large liver tumors due to HCC, instilling confidence in the future of HCC treatment. Positive prognostic factors included patient age, EQD2, and BED10.

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