title: Adjuvant stereotactic body radiotherapy following transarterial chemoembolization in patients with non-resectable hepatocellular carcinoma tumours of ≥ 3 cm.
abstract: OBJECTIVE
  The optimal locoregional treatment for non-resectable hepatocellular carcinoma (HCC) of ≥ 3 cm in diameter is unclear. Transarterial chemoembolization (TACE) is the initial intervention most commonly performed, but it rarely eradicates HCC. The purpose of this study was to measure survival in HCC patients treated with adjuvant stereotactic body radiotherapy (SBRT) following TACE.
  
  
  METHODS
  A retrospective study of patients with HCC of ≥ 3 cm was conducted. Outcomes in patients treated with TACE alone (n = 124) were compared with outcomes in those treated with TACE + SBRT (n = 37).
  
  
  RESULTS
  There were no significant baseline differences between the two groups. The pre-TACE mean number of tumours (P = 0.57), largest tumour size (P = 0.09) and total tumour diameter (P = 0.21) did not differ significantly between the groups. Necrosis of the HCC tumour, measured after the first TACE, did not differ between the groups (P = 0.69). Local recurrence was significantly decreased in the TACE + SBRT group (10.8%) in comparison with the TACE-only group (25.8%) (P = 0.04). After censoring for liver transplantation, overall survival was found to be significantly increased in the TACE + SBRT group compared with the TACE-only group (33 months and 20 months, respectively; P = 0.02).
  
  
  CONCLUSIONS
  This retrospective study suggests that in patients with HCC tumours of ≥ 3 cm, treatment with TACE + SBRT provides a survival advantage over treatment with only TACE. Confirmation of this observation requires that the concept be tested in a prospective, randomized clinical trial.
authors.affiliation: Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Rojymon
authors.initials: R
authors.lastname: Jacob
authors.forename: Falynn
authors.initials: F
authors.lastname: Turley
authors.forename: David T
authors.initials: DT
authors.lastname: Redden
authors.forename: Souheil
authors.initials: S
authors.lastname: Saddekni
authors.forename: Ahmed K A
authors.initials: AK
authors.lastname: Aal
authors.forename: Kimberly
authors.initials: K
authors.lastname: Keene
authors.forename: Eddy
authors.initials: E
authors.lastname: Yang
authors.forename: Jessica
authors.initials: J
authors.lastname: Zarzour
authors.forename: David
authors.initials: D
authors.lastname: Bolus
authors.forename: J Kevin
authors.initials: JK
authors.lastname: Smith
authors.forename: Stephen
authors.initials: S
authors.lastname: Gray
authors.forename: Jared
authors.initials: J
authors.lastname: White
authors.forename: Devin E
authors.initials: DE
authors.lastname: Eckhoff
authors.forename: Derek A
authors.initials: DA
authors.lastname: DuBay
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D016461:Chemoembolization, Therapeutic / Q000379:methods; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery; D018714:Radiotherapy, Adjuvant / Q000379:methods; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed