Stereotactic Body Radiotherapy versus Radiofrequency Ablation as Initial Treatment of Small Hepatocellular Carcinoma

Abstract Background/Aim: Resection or ablative therapy is not indicated for many patients with hepatocellular carcinoma (HCC) because of advanced cirrhosis or the tumor location. Stereotactic body radiotherapy (SBRT) may be an alternative treatment for these patients. This study compared the therapeutic effects of radiofrequency ablation (RFA) and SBRT in patients with small (≤ 3 cm) HCCs.Methods: Data of HCC patients who underwent SBRT or RFA as an initial treatment at four tertiary referral hospitals between March 2011 and February 2017 were reviewed. The patient inclusion criteria were a single nodule measuring ≤ 3 cm in size and not suitable for resection.Results: SBRT and RFA were performed for 72 (SBRT group) and 134 (RFA group) patients, respectively. The 1-, 3- and 5-year overall survival (OS) rates were 97.0%, 80.3%, and 80.3%, respectively, in the SBRT group compared with 98.5%, 83.9%, and 80.8%, respectively, in the RFA group, with no significant differences between the groups (P = 0.81). The estimated five-year local control (LC) rate was 68.1% in the SBRT group and 73.1% in the RFA group (P = 0.81). In the SBRT group analysis, both SBRT alone (n=34) and SBRT combined with transarterial chemoembolization (n=38) showed no difference with RFA in OS (p = 0.72) or LC rate (p = 0.95).Conclusion: SBRT is an effective and safe treatment method for small HCCs, with survival and tumor recurrence rates similar to those of RFA.