Stereotactic body radiation therapy beneficial for patients with locally advanced HCC

Stereotactic body radiation therapy (SBRT) followed by sorafenib outperformed sorafenib alone in patients with advanced hepatocellular carcinoma (HCC) in a phase 3 trial, adding this technique to the armamentarium of treatment options for patients with HCC, particularly those with locally advanced disease and microvascular invasion.

The phase 3 NRG/RTOG1112 trial (NCT01730937) aimed to evaluate the role of SBRT plus systemic therapy in patients with HCC [1]. In total, 193 patients with locally advanced HCC who were ineligible to receive surgery, radiofrequency ablation, or transarterial chemoembolisation were randomised 1:1 to the former standard-of-care, sorafenib, or to SBRT, 27.5-50 Gy in 5 fractions, followed by sorafenib. Prof. Laura Dawson (Princess Margaret Cancer Centre, Canada) emphasised that approximately 75% of the included patients had microvascular invasion.

The overall survival (OS) appeared to be improved in patients in the SBRT arm compared with those in the control arm (median OS 15.3 months vs 12.3 months; HR 0.77; 90% CI 0.59–1.01; 1-sided P=0.055). Next, progression-free survival (PFS) results favoured the experimental arm over the control arm (median PFS 9.2 months vs 5.5 months; HR 0.55; 95% CI 0.40–0.75; P=0.0001). The rates of grade 3 or higher adverse events were comparable for the study groups (74% and 75%). Finally, the FACT-Hep questionnaire suggested a quality-of-life benefit for patients in the SBRT arm compared with the control arm, with 35% and 10% reporting an improvement by at least 5 points in the respective arms.

“SBRT is a standard treatment option for patients with locally advanced HCC, especially in patients with microvascular invasion,” concluded Prof. Dawson. Dr Laura Williams Goff (Vanderbilt University Medical Center, TN, USA), discussant of this abstract, concluded: “SBRT plus sorafenib is particularly attractive for patients who cannot receive immunotherapy as post-transplant recurrence.”

1. Dawson LA, et al. NRG/RTOG 1112: Randomized phase III study of sorafenib vs. stereotactic body radiation therapy (SBRT) followed by sorafenib in hepatocellular carcinoma (HCC). Abstract 489, ASCO GI 2023, 19–21 January, San Francisco, CA, USA.

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Posted on 17 March 2023