title: Radiofrequency ablation versus stereotactic body radiotherapy for small hepatocellular carcinoma: a Markov model-based analysis.
abstract: The aim of this study is to compare radiofrequency ablation (RFA) with stereotactic body radiotherapy (SBRT) for hepatocellular carcinomas (HCC) smaller than 3 cm. A Markov cohort model was developed to simulate a cohort of patients aged 60-65 years with small HCCs who had undergone either RFA or SBRT and were followed up over their remaining life expectancy. The inclusion criteria were: (1) HCC ≤3 cm in diameter with ≤ 3 nodules; (2) absence of extrahepatic metastasis or portal/hepatic vein invasion; (3) Child-Pugh Class A or B. Twenty thousand virtual patients were randomly assigned to undergo RFA or SBRT. Predicted life expectancy was 6.452 and 6.371 years in the RFA and SBRT groups, respectively. The probability distributions of the expected overall survival were nearly identical. The 95% confidence intervals were 6.25-6.66 and 6.17-6.58 years for RFA and SBRT, respectively. The difference between RFA and SBRT was insignificant (P = 0.2884). Two-way sensitivity analysis demonstrated that if the tumor is 2-3 cm, SBRT is the preferred treatment option. Our Markov model has shown that expected overall survival of SBRT is nearly identical to RFA in HCCs smaller than 3 cm, but SBRT may have an advantage for tumors 2 cm and larger. A randomized trial is required to confirm these findings.
authors.affiliation: Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea.
authors.forename: Young-Seok
authors.initials: YS
authors.lastname: Seo
authors.affiliation: Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea.
authors.forename: Mi-Sook
authors.initials: MS
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea.
authors.forename: Hyung-Jun
authors.initials: HJ
authors.lastname: Yoo
authors.affiliation: Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea.
authors.forename: Won Il
authors.initials: WI
authors.lastname: Jang
authors.affiliation: Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea.
authors.forename: Eun Kyung
authors.initials: EK
authors.lastname: Paik
authors.affiliation: Department of Internal Medicine, Korea Institute of Radiological & Medical Sciences, Seoul, Korea.
authors.forename: Chul Ju
authors.initials: CJ
authors.lastname: Han
authors.affiliation: Department of Radiology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea.
authors.forename: Byung-Hee
authors.initials: BH
authors.lastname: Lee
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy*; D017115:Catheter Ablation / Q000379:methods; D003198:Computer Simulation; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009010:Monte Carlo Method; D009367:Neoplasm Staging; D016634:Radiosurgery / Q000379:methods; D015203:Reproducibility of Results; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Hepatocellular carcinoma; Markov; radiofrequency ablation; stereotactic