A phase 3 clinical trial suggests that stereotactic body radiation therapy (SBRT) prior to systemic treatment may improve survival outcomes for patients with locally advanced hepatocellular carcinoma (HCC), although the findings were not statistically significant.
The trial compared the effects of SBRT followed by sorafenib, a standard systemic therapy, with sorafenib alone in 177 eligible patients. Most participants (75%) had macrovascular invasion, a severe form of HCC. Median overall survival (OS) was 15.8 months for those receiving SBRT and sorafenib, compared with 12.3 months for sorafenib alone (hazard ratio [HR] 0.77, one-sided P = .06). After adjusting for clinical factors, OS improvement with SBRT was statistically significant (HR 0.72, P = .04).
Progression-free survival (PFS) was notably better with SBRT, increasing from 5.5 months with sorafenib alone to 9.2 months when combined with SBRT (HR 0.55, P < .001). Adverse events of grade 3 or higher were comparable between the two groups, and SBRT patients reported improved quality of life six months after treatment.
The trial was halted early due to evolving systemic therapy standards, limiting definitive conclusions. However, the findings highlight SBRT’s potential to enhance treatment outcomes for advanced HCC.
Experts suggest that SBRT could be a valuable option for select patients, warranting further research to refine treatment strategies and improve survival in this aggressive cancer.
Helena Bradbury, EMJ
Reference
Dawson LA et al. Stereotactic body radiotherapy vs sorafenib alone in hepatocellular carcinoma: The NRG oncology/RTOG 1112 phase 3 randomized clinical trial. JAMA Oncol. 2024. doi:10.1001/jamaoncol.2024.5403.
