Stereotactic body radiotherapy versus hepatic resection for recurrent small hepatocellular carcinoma: A post-hoc analysis with propensity score adjustment from two randomized trials
Menée à l'aide des données de 2 essais randomisés incluant au total 158 patients atteints d'un carcinome hépatocellulaire récidivant et de petite taille, cette étude évalue l'efficacité, du point de vue de la survie sans progression locale, d'une radiothérapie stéréotaxique par rapport à une résection hépatique
Background: Stereotactic body radiotherapy (SBRT) has been proven effective for treating small hepatocellular carcinoma (sHCC); however, the comparative efficacy of SBRT and surgical resection remains unknown. This analysis aims to compare the outcomes of SBRT and resection in treating recurrent sHCC.
Methods: Two randomized controlled trials enrolled recurrent sHCC undergoing resection (NCT01833286) or SBRT (NCT04047173). Patients with single recurrent HCC ≤ 5 cm were included in this study. The primary endpoint was local progression-free survival (LPFS).
Results: A total of 158 patients were included, with 83 and 75 patients assigned to the SBRT and resection cohorts, respectively. The cumulative 3-year LPFS rates were 84.3% (95% CI, 76.1 to 92.5) with SBRT and 76.8% (95% CI, 67.2 to 86.4) with resection, respectively (HR, 0.70 [95% CI, 0.35 to 1.40]; P=0.311). The median progression-free survival time of the SBRT and resection group was 37.6 (95% CI, 26.0 to 49.2) and 26.3 (95% CI, 18.8 to 33.8) months, respectively, with no significant differences (HR, 0.80 [95% CI, 0.53 to 1.21]; P=0.287). The 3-year overall survival rates were 90.3% (95% CI, 83.4 to 97.2) in the SBRT group, and 81.1% (95% CI, 76.5 to 90.1) in the resection group (HR, 0.53 [95% CI, 0.23 to 1.20]; P=0.118). The comparison results remained consistent after adjusting for confounding variables. The incidences of adverse events were similar between the two groups (P=0.695).
Conclusions: SBRT provides satisfactory tumor control and long-term outcomes, comparable to those of resection. SBRT could be a potential alternative to resection in recurrent sHCC.
European Journal of Cancer , résumé, 2026