title: Outcomes After Stereotactic Body Radiotherapy or Radiofrequency Ablation for Hepatocellular Carcinoma.
abstract: OBJECTIVE
  Data guiding selection of nonsurgical treatment of hepatocellular carcinoma (HCC) are lacking. We therefore compared outcomes between stereotactic body radiotherapy (SBRT) and radiofrequency ablation (RFA) for HCC.
  
  
  METHODS
  From 2004 to 2012, 224 patients with inoperable, nonmetastatic HCC underwent RFA (n = 161) to 249 tumors or image-guided SBRT (n = 63) to 83 tumors. We applied inverse probability of treatment weighting to adjust for imbalances in treatment assignment. Freedom from local progression (FFLP) and toxicity were retrospectively analyzed.
  
  
  RESULTS
  RFA and SBRT groups were similar with respect to number of lesions treated per patient, type of underlying liver disease, and tumor size (median, 1.8 v 2.2 cm in maximum diameter; P = .14). However, the SBRT group had lower pretreatment Child-Pugh scores (P = .003), higher pretreatment alpha-fetoprotein levels (P = .04), and a greater number of prior liver-directed treatments (P < .001). One- and 2-year FFLP for tumors treated with RFA were 83.6% and 80.2% v 97.4% and 83.8% for SBRT. Increasing tumor size predicted for FFLP in patients treated with RFA (hazard ratio [HR], 1.54 per cm; P = .006), but not with SBRT (HR, 1.21 per cm; P = .617). For tumors ≥ 2 cm, there was decreased FFLP for RFA compared with SBRT (HR, 3.35; P = .025). Acute grade 3+ complications occurred after 11% and 5% of RFA and SBRT treatments, respectively (P = .31). Overall survival 1 and 2 years after treatment was 70% and 53% after RFA and 74% and 46% after SBRT.
  
  
  CONCLUSIONS
  Both RFA and SBRT are effective local treatment options for inoperable HCC. Although these data are retrospective, SBRT appears to be a reasonable first-line treatment of inoperable, larger HCC.
authors.affiliation: Daniel R. Wahl, Matthew H. Stenmark, Yebin Tao, Erqi L. Pollom, Elaine M. Caoili, Theodore S. Lawrence, Matthew J. Schipper, and Mary Feng, University of Michigan Medical Center; and Matthew H. Stenmark, Veterans Affairs Medical Center, Ann Arbor, MI.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Wahl
authors.affiliation: Daniel R. Wahl, Matthew H. Stenmark, Yebin Tao, Erqi L. Pollom, Elaine M. Caoili, Theodore S. Lawrence, Matthew J. Schipper, and Mary Feng, University of Michigan Medical Center; and Matthew H. Stenmark, Veterans Affairs Medical Center, Ann Arbor, MI.
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Stenmark
authors.affiliation: Daniel R. Wahl, Matthew H. Stenmark, Yebin Tao, Erqi L. Pollom, Elaine M. Caoili, Theodore S. Lawrence, Matthew J. Schipper, and Mary Feng, University of Michigan Medical Center; and Matthew H. Stenmark, Veterans Affairs Medical Center, Ann Arbor, MI.
authors.forename: Yebin
authors.initials: Y
authors.lastname: Tao
authors.affiliation: Daniel R. Wahl, Matthew H. Stenmark, Yebin Tao, Erqi L. Pollom, Elaine M. Caoili, Theodore S. Lawrence, Matthew J. Schipper, and Mary Feng, University of Michigan Medical Center; and Matthew H. Stenmark, Veterans Affairs Medical Center, Ann Arbor, MI.
authors.forename: Erqi L
authors.initials: EL
authors.lastname: Pollom
authors.affiliation: Daniel R. Wahl, Matthew H. Stenmark, Yebin Tao, Erqi L. Pollom, Elaine M. Caoili, Theodore S. Lawrence, Matthew J. Schipper, and Mary Feng, University of Michigan Medical Center; and Matthew H. Stenmark, Veterans Affairs Medical Center, Ann Arbor, MI.
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Caoili
authors.affiliation: Daniel R. Wahl, Matthew H. Stenmark, Yebin Tao, Erqi L. Pollom, Elaine M. Caoili, Theodore S. Lawrence, Matthew J. Schipper, and Mary Feng, University of Michigan Medical Center; and Matthew H. Stenmark, Veterans Affairs Medical Center, Ann Arbor, MI.
authors.forename: Theodore S
authors.initials: TS
authors.lastname: Lawrence
authors.affiliation: Daniel R. Wahl, Matthew H. Stenmark, Yebin Tao, Erqi L. Pollom, Elaine M. Caoili, Theodore S. Lawrence, Matthew J. Schipper, and Mary Feng, University of Michigan Medical Center; and Matthew H. Stenmark, Veterans Affairs Medical Center, Ann Arbor, MI.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Schipper
authors.affiliation: Daniel R. Wahl, Matthew H. Stenmark, Yebin Tao, Erqi L. Pollom, Elaine M. Caoili, Theodore S. Lawrence, Matthew J. Schipper, and Mary Feng, University of Michigan Medical Center; and Matthew H. Stenmark, Veterans Affairs Medical Center, Ann Arbor, MI. maryfeng@med.umich.edu.
authors.forename: Mary
authors.initials: M
authors.lastname: Feng
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D016634:Radiosurgery / Q000401:mortality*; D012189:Retrospective Studies; D015996:Survival Rate