Introduction: We aimed to investigate whether concurrent use of intrahepatic external beam radiotherapy (EBRT) is a viable option for patients with advanced hepatocellular carcinoma (HCC) undergoing tyrosine kinase inhibitor (TKI) therapy. Methods: A total of 453 patients with Barcelona Clinic Liver Cancer-stage C (BCLC-C) HCC, who started first-line treatment with TKI with intrahepatic EBRT (TKI + RT, n = 97) or TKI without intrahepatic EBRT (TKI, n = 356) were analyzed. The overall survival (OS) and progression-free survival (PFS) were compared in the overall cohort, patients who received at least 8 weeks of TKI treatment, and a propensity score-matched cohort. Results: OS and PFS was better in those treated with TKI + RT than TKI (8.6 vs. 4.4 months and 4.5 vs. 2.3 months, respectively, with p < 0.001). Of note, the TKI + RT group demonstrated significant longer time-to-intrahepatic tumor progression. In subgroup analysis, TKI + RT led to better OS than TKI in all subgroups and PFS was significantly improved in patients without extrahepatic metastasis, and those with portal vein invasion. There was no significant difference in treatment discontinuation due to adverse events between the TKI + RT and TKI groups (32.0% vs. 37.9%, p = 0.34). Furthermore, patients treated with TKI + RT showed better liver function preservation over time compared to TKI without intrahepatic EBRT. Comparable treatment outcomes were observed between patients who received at least 8 weeks of TKI treatment and the propensity-score matched cohort. Discussion/Conclusion: Concurrent intrahepatic EBRT targeting liver and/or macrovascular invasion can be a viable option to improve outcomes of BCLC-stage C patients receiving TKI therapy with an aim to control intrahepatic progression and preserving liver function.


中文翻译：

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肝内外照射放疗对接受酪氨酸激酶抑制剂治疗的晚期肝细胞癌患者的影响

简介：我们的目的是研究对于接受酪氨酸激酶抑制剂（TKI）治疗的晚期肝细胞癌（HCC）患者来说，同时使用肝内外照射放疗（EBRT）是否是一个可行的选择。方法：共有 453 名巴塞罗那临床肝癌 C 期 (BCLC-C) HCC 患者开始一线治疗，接受 TKI 联合肝内 EBRT（TKI + RT，n = 97）或 TKI 不联合肝内 EBRT（TKI， n = 356）进行了分析。比较总体队列、接受至少 8 周 TKI 治疗的患者以及倾向评分匹配队列的总生存期 (OS) 和无进展生存期 (PFS)。结果：TKI + RT 治疗组的 OS 和 PFS 优于 TKI（分别为 8.6 个月与 4.4 个月和 4.5 个月与 2.3 个月，p < 0.001）。值得注意的是，TKI + RT 组表现出肝内肿瘤进展时间显着延长。在亚组分析中，TKI + RT 在所有亚组中均比 TKI 带来更好的 OS，并且无肝外转移和门静脉侵犯患者的 PFS 显着改善。TKI + RT 组和 TKI 组之间因不良事件而停止治疗的情况没有显着差异（32.0% vs. 37.9%，p = 0.34）。此外，与不进行肝内 EBRT 的 TKI 治疗相比，接受 TKI + RT 治疗的患者随着时间的推移显示出更好的肝功能保存。在接受至少 8 周 TKI 治疗的患者和倾向评分匹配队列的患者之间观察到了可比较的治疗结果。讨论/结论：针对肝脏和/或大血管侵犯的同步肝内 EBRT 可能是改善接受 TKI 治疗的 BCLC C 期患者预后的可行选择，旨在控制肝内进展并保留肝功能。