Introduction

Hepatic resection is recommended as a curative treatment for hepatocellular carcinoma (HCC), but it may not always be feasible due to tumor localization, liver function, and comorbidities. On the other hand, carbon ion radiotherapy (CIRT) has recently become covered by health insurance in Japan, offering low invasiveness and promising local control. In this study, we compared the treatment outcomes of primary HCC between hepatic resection and CIRT.

Aims & Methods

We compared the treatment outcomes of CIRT (CIRT group, n=111) and hepatic resection (HR group, n=947) for primary HCC from September 2010 to June 2022. Patient backgrounds were adjusted using inverse probability of treatment weighting (IPTW), and we compared the recurrence-free survival (RFS) and overall survival (OS).

Results

CIRT group: HR group, median age 74 (IQR 67-82) years: 71 (65-77) years (p<0.001), male 81 cases (73.0%): 748 cases (79.0%) (p=0.1), PS 0/1=71 cases (64.0%)/40 cases (36.0%): 890 cases (94.0%)/57 cases (6.0%) (p<0.001), Child-Pugh classification A/B=102 cases (91.9%)/9 cases (8.1%): 899 cases (94.9%)/48 cases (5.1%) (p=0.2), solitary/multiple tumors=104 cases (93.7%)/7 cases (6.3%): 729 cases (77.0%)/218 cases (23.0%) (p<0.001), tumor size 3.7 (2.6-5.5) cm: 3.3 (2.2-5.3) cm (p=0.07). The CIRT group had a higher median age, poorer PS, and more solitary cases. The median RFS before IPTW adjustment was 2.3 years in the CIRT group and 2.8 years in the HR group with no significant difference (p=0.1), and there was no significant difference after IPTW adjustment (p=0.5). The median OS was 7.4 years in the CIRT group and 10.1 years in the HR group with a significant difference before IPTW adjustment (p=0.01), but the difference disappeared after IPTW adjustment (9.6 years vs. 10.1 years, p=0.6). In cases with a maximum tumor diameter of 4 cm or more, which is covered by insurance, there was no significant difference in RFS and OS before and after IPTW adjustment (RFS: p=0.8, 0.4; OS: p=0.4, 0.5). Multivariate analysis for RFS and OS showed that treatment modality (CIRT/HR) was not a significant factor (p=0.06, 0.2).

Conclusion

Carbon ion radiotherapy demonstrated comparable local control and prognosis to hepatic resection, suggesting its potential as one of the options for curative treatment.

Introduction

The combination of Atezolizumab plus Bevacizumab (atezobeva) has changed the treatment landscape of advanced hepatocellular carcinoma (HCC), but its efficacy and safety in patients with impaired liver function or portal hypertension is still debated.

Aims & Methods

In this multicenter, real-life, study we compared 247 patients with unresectable HCC treated with atezobeva, matched to 494 patients treated with tyrosine kinase inhibitors (TKIs). We evaluated the impact of liver function and decompensation on treatment outcomes.

Results

Patients in the atezobeva group showed longer median overall survival (OS; 18·30 vs 10·20 months, p<0·0001), longer time to progression (TTP; 13·60 vs 10·10 months, p=0·0002) and increased progression-free survival (PFS; 10·50 VS 6·10 months, p<0·0001) compared with the TKIs group. Although survival was better in Child Pugh A patients than in Child Pugh B patients (20·20 vs 9·83 months, p=0·0008), no clear differences in TTP and overall treatment safety were observed· Liver decompensation occurred in 63 (25·51%) patients, specifically 41 (27·89%) Child Pugh A and 22 (51·16%) Child Pugh B and was associated with worse survival (10·50 vs 20·20 months; p=0·006). Among decompensated patients, 26 patients (41·26%) were able to resume atezobeva after decompensation, achieving an OS comparable to those who never decompensated (20·87 vs 20·2 months; p=0·77), and significantly better than those who permanently stopped treatment (8·07 months; p=0·02). Treatment interruption following decompensation was an independent predictor of survival (HR 2·04, 95% CI 1·25-3·33, p=0·004), while ALBI score 2-3 (HR 2·21, 95%CI 1·07-4·55; p=0·03), Child Pugh class B (HR 1·81, 95% CI 1·03-3·18; p=0·04), portal hypertension (HR 2·54, 95%CI 1·37-4·72; p=0·003) and sAEs (HR 1·71, 95%CI 1·04-2·82; p=0·04) emerged as predictors of decompensation. Time to decompensation was similar for patients with ALBI 2, regardless of Child Pugh class, and the probability of recovery from decompensation was similar for Child A and B patients.

Conclusion

In this real-life multicentric study atezobeva was effective in both Child Pugh A and B patients. Child Pugh B patients despite their higher risk of decompensation have an equal chance of recovery. The possibility to resume treatment after an episode of decompensation highlights the necessity of integrated hepato-oncological management, optimizing the therapeutic efficacy of atezobeva.

References

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Disclosure

​None