SABR yields better survival, tumour control in oligometastatic HCC

Treatment with stereotactic ablative radiotherapy (SABR) results in excellent local tumour control and improves survival among patients with oligometastatic hepatocellular carcinoma (HCC), with no serious adverse effects, reports a study.

Forty patients with controlled primary HCC and one to five metastatic lesions were enrolled in this study and received SABR on a total of 62 lesions between 2021 and 2022.

Treatment efficacy, the primary endpoint, was defined as overall survival (OS) and progression-free survival (PFS). Secondary endpoints were time to local progression, objective response rate, disease control rate, toxicities, and quality of life (QoL), assessed using the EORTC QLQ-C30 before and 0, 1, and 3 months after SABR.

The most common location for oligometastatic disease (OMD) was the lungs (48.4 percent), followed by the lymph nodes (22.6 percent) and bone (17.7 percent). The 2-year OS after a median follow-up of 15.5 months was 80 percent, while the median PFS was 5.3 months, with 1- and 2-year PFS rates of 21.2 percent and 0 percent, respectively.

A shorter time to OMD from the controlled primary HCC was independently associated with PFS (p=0.039; hazard ratio, 2.127), as was age (p=0.002), Child-Pugh class (p=0.004), and alpha-fetoprotein (p=0.019). Additionally, the rates of 2-year time to local progression, objective response, and disease control were 91.1 percent, 75.8 percent, and 98.4 percent, respectively.

In terms of safety, 10 percent of patients had acute toxicity, and 7.5 percent late toxicity, with no grade 3+ toxicity reported. All QoL scores remained stable, and patients without systemic treatments showed improvements in insomnia and social function.

“SABR is an effective and safe treatment option for oligometastatic HCC, yielding excellent local tumour control and survival improvement without worsening patients’ QoL, regardless of tumour sites,” the researchers said. “We also demonstrated that patients with a later presentation of OMD from the controlled primary and lower alpha-fetoprotein levels achieved better survival outcomes.”