605 Background: Multiple treatment modalities are available for localized hepatocellular carcinoma (HCC), and current Barcelona Clinic Liver Cancer (BCLC) guidelines recommend ablation for patients with a limited number of small tumors, not amenable to resection or transplantation. However, in recent years, stereotactic body radiation therapy (SBRT) has been increasingly used for localized disease. Patient outcomes based on treatment modality are not well understood. Methods: We conducted a retrospective analysis using the National Cancer Database (NCDB) to identify patients with a history of stage I/II HCC with tumors ≤ 5 cm who had received local therapy with either radiofrequency ablation (RFA) or SBRT between 2006 and 2021. A propensity score matched analysis was conducted accounting for patient demographics, facility region and tumor level characteristics, as well as an inverse probability of treatment weight-adjusted (IPTW) analysis. Overall survival was estimated using the Kaplan-Meier method. Results: We identified 14,516 patients meeting inclusion criteria, including 13,036 who received RFA and 1,480 who received SBRT. Demographic factors associated with receipt of SBRT included age >50 years, female sex, and treatment in the Middle Atlantic and East North Central regions, as well as clinical factors including larger tumor size (>3 to 5 cm), severe fibrosis/cirrhosis, and stage II disease ( p <0.05 for all). Factors associated with receipt of RFA include black race, higher Charlson-Deyo Comorbidity Scores, treatment at a comprehensive cancer program or integrated network cancer program, and treatment in the East South Central, West North Central, West South Central, Mountain, and Pacific Regions ( p <0.05 for all). Median time from diagnosis to treatment initiation was longer for those who received SBRT (66.3 vs 84.6 days, p <0.001). In a propensity matched analysis, mOS was 45.1 months for those receiving RFA vs 30.8 months for those receiving SBRT ( p <0.001). An IPTW analysis showed similar survival benefit with RFA over SBRT (mOS 51.0 vs 30.5 months, p <0.001). This OS benefit was observed in subset of patients with tumors <3cm in size. Conclusions: In this propensity matched analysis controlling for relevant patient and tumor factors, RFA was associated with improved survival. Prospective studies will be important to further analyze differences in patient outcomes.
Ailawadi et al. (Sat,) studied this question.