ESTRO 2024 - Abstract Book

S2187

Clinical - Upper GI

ESTRO 2024

1117

Digital Poster

COMPARING RESECTION AND STEREOTACTIC BODY RADIATION THERAPY FOR HCC WITH MACROVASCULA R INVASION

Michael Yan 1 , Zhihao Li 2 , Pablo Munoz-Schuffenegger 3 , Anna Theresa Santiago 4 , Christian TJ Magyar 2 , Marco PA Claasen 2 , Nadia Rukavina 2 , Roxana Bucur 2 , Ian McGilvray 2 , Carol-Anne Moulton 2 , Trevor Reichman 2 , Chaya Shwaartz 2 , Sean Cleary 2 , Grainne O'Kane 5 , Arndt Vogel 6 , Robert Grant 5 , Tae Kyoung Kim 7 , Catherine Soo-Yee Naidoo 7 , Ali Hosni 1 , Rebecca Wong 1 , Aruz Mesci 1 , Jelena Lukovic 1 , John Kim 1 , Gonzalo Sapisochin 2 , Laura Dawson 1 1 Princess Margaret Cancer Centre, Radiation Medicine Program, Toronto, Canada. 2 University of Toronto, Department of Surgery, Toronto, Canada. 3 Pontificia Universidad Catolica de Chile, Radiation Oncology, Santiago, Chile. 4 Princess Margaret Cancer Centre, Biostatistics, Toronto, Canada. 5 Princess Margaret Cancer Centre, Hematology and Medical Oncology, Toronto, Canada. 6 University of Toronto, Department of Medicine, Toronto, Canada. 7 University of Toronto, Department of Radiology, Toronto, Canada

Purpose/Objective:

Macrovascular invasion (MVI) in hepatocellular carcinoma (HCC) patients is a poor prognostic factor associated with early recurrence and worse overall survival. Current guidelines endorse systemic therapy for MVI, e.g. atezolizumab/bevacizumab and tremelimumab/durvalumab. Nevertheless, local therapies present a potential for obliteration o f MVI and improved survival. While surgery has been the preferred local treatment at our institution, stereotactic body radiotherapy (SBRT) is increasingly recognized as a viable alternative for HCC patients with MVI.

Material/Methods:

In this retrospective study, propensity score matching was used to compare outcomes of HCC patients with MVI who underwent surgery or received SBRT. Matching was done based on sex, age group, ECOG performance status, cirrhosis presence, Child-Pugh class, number of HCC tumors, tumor volume, alpha-fetoprotein level, ALBI score, portal vein tumor thrombosis classification, and hepatic vein involvement. Our analysis included overall survival with Kaplan-Meier and log-rank tests, and recurrence-free survival using cumulative incidence analysis with Gray's test.

Results:

Following balanced matching of 193 patients, 90 patients were included (45 patients in both the surgery and SBRT groups). Table 1 summarizes patient and HCC characteristics in each group. The SBRT group exhibited a median survival of 15 months (95% CI: 10-38), and median survival in the surgery group was 24 months (95% CI: 11-81), P=0.16. Comparing the 12-, 36-, and 60-month overall survival (OS) rates between the SBRT group (57%, 33%, 15%) and the surgery group (58%, 37%, 34%), there was no statistically significant differences (log-rank test P=0.16); the 5 year OS was double in the surgical resection group (Resection: 8 patients, SBRT: 4 patients remaining at risk). The