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SIRT Compared with DEB-TACE for Hepatocellular Carcinoma: a Real-world Study (the SITAR Study)

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Abstract

Background

Hepatocellular carcinoma (HCC) is responsible for 1% of deaths worldwide, and the incidence continues to increase. Despite surveillance programs, 70% of HCC patients are not suitable for curative options at diagnosis, and therefore, non-curative treatments are essential to modern clinical practice. There are many novel treatments, though their roles are not well defined. This study aimed to contrast Selective Internal Radiation Therapy (SIRT) and Drug Eluting Bead Transarterial Chemoembolisation (DEB-TACE) to further define their roles.

Methods

This was a retrospective multicentre cohort study. Factors included for analysis were type of HCC treatment, number of lesions, lesion size, multiple disease severity scores, cirrhosis and vascular invasion. The primary endpoint was transplant-free survival.

Results

Transplant-free survival was similar between the two cohorts (p = 0.654), despite a variation in median lesion size, SIRT: 54.5 mm, DEB-TACE: 34 mm (p ≤ 0.001). A univariate Cox proportional hazard model utilising treatment modality as the covariate showed no significant difference in survival (DEB-TACE HR 1.4 (95%CI 0.85–2.15 p = 0.207). The size of the largest lesion was the best predictor of 3-year survival (p = 0.035). Lesion size was inversely associated with survival (HR 1.01 (95%CI 1–1.02, p = 0.025)) on multivariate analysis.

Conclusion

This study is the first to catalogue the experience of using SIRT in HCC in a real-world Australian population. It has demonstrated no difference in survival outcomes between DEB-TACE and SIRT. Further, it has shown SIRT to be a reasonable alternative to DEB-TACE especially in larger lesions and has demonstrated that DEB-TACE has a role in select patients with advanced disease.

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Abbreviations

HCC:

Hepatocellular carcinoma

SIRT:

Selective Internal Radiation Therapy

DEB-TACE:

Drug Eluting Bead Transarterial Chemoembolisation

BCLC:

Barcelona Clinic Liver Cancer

EASL:

European Association for the Study of the Liver

AASLD:

American Association for Study of Liver Disease

ECOG:

Eastern Cooperative Oncology Group

TACE:

Transarterial chemoembolisation

mRECIST:

Modified Response Evaluation Criteria in Solid Tumours

MELD:

Model for End-Stage Liver Disease

CP:

Child–Pugh

IQR:

Interquartile range

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Authors and Affiliations

  1. Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia

    Ryan D. Hirsch, Rohit Sawhney & Amanda J. Nicoll

  2. Gastroenterology, Eastern Health, 3W Box Hill Hospital, 8 Arnold St, Box Hill, VIC, 3128, Australia

    Ryan D. Hirsch, Rohit Sawhney & Amanda J. Nicoll

  3. Gastroenterology, Austin Health, Heidelberg, Victoria, Australia

    Chris Mills & Paul Gow

  4. Gastroenterology and Hepatology, Melbourne Health, Parkville, Victoria, Australia

    Siddharth Sood, Virginia Bird & Amanda J. Nicoll

  5. Gastroenterology, Monash Health, Clayton, Victoria, Australia

    Gauri Mishra & Anouk Dev

  6. Gastroenterology, Alfred Health, Melbourne, Victoria, Australia

    William Kemp, John Lubel & Stuart K. Roberts

  7. Central Clinical School, Monash University, Melbourne, Victoria, Australia

    William Kemp, John Lubel & Stuart K. Roberts

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  1. Ryan D. Hirsch
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Correspondence to Ryan D. Hirsch.

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Lay Summary

SIRT is a reasonable alternative to DEB-TACE especially in larger lesions. DEB-TACE has a role in select patients with advanced disease.

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Hirsch, R.D., Mills, C., Sawhney, R. et al. SIRT Compared with DEB-TACE for Hepatocellular Carcinoma: a Real-world Study (the SITAR Study). J Gastrointest Canc 52, 907–914 (2021). https://doi.org/10.1007/s12029-020-00502-z

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  • DOI: https://doi.org/10.1007/s12029-020-00502-z

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