CT-guided High-Dose-Rate Brachytherapy versus Transarterial Chemoembolization in Patients with Unresectable
Timo A Auer1, Lukas Müller1, Daniel Schulze1
1From the Department of Radiology, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany (T.A.A., M.A., B.G., F.C.); Berlin Institute of Health, Berlin, Germany (T.A.A., F.C.); Department of Diagnostic and Interventional Radiology, University Medical Center, Mainz, Mainz, Germany (L.M.); Institute of Biometry and Clinical Epidemiology, Charité Universitätsmedizin Berlin, Berlin, Germany (D.S.); Department of Medicine II, University of Freiburg Medical Center, Freiburg, Germany (D.B.); Department of Diagnostic and Interventional Radiology, University Medical Center Heidelberg, Heidelberg, Germany (V.S.); Institute of Diagnostic and Interventional Radiology and Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany (J.H.); Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (D.Z., D.P.d.S.); Institute of Diagnostic and Interventional Radiology, University Hospital of Frankfurt, Frankfurt, Germany (D.P.d.S.); Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany (M.E.); and Institute of Interventional Radiology, University Hospital Schleswig-Holstein-Campus Lübeck, Lübeck, Germany (R.K.).
Abstract:
Background CT-guided high-dose-rate (HDR) brachytherapy (hereafter, HDR brachytherapy) has been shown to be safe and effective for patients with unresectable hepatocellular carcinoma (HCC), but studies comparing this therapy with other local-regional therapies are scarce. Purpose To compare patient outcomes of HDR brachytherapy and transarterial chemoembolization (TACE) in patients with unresectable HCC. Materials and Methods This multi-institutional retrospective study included consecutive treatment-naive adult patients with unresectable HCC who underwent either HDR brachytherapy or TACE between January 2010 and December 2022. Overall survival (OS) and progression-free survival (PFS) were compared between patients matched for clinical and tumor characteristics by propensity score matching. Not all patients who underwent TACE had PFS available; thus, a different set of patients was used for PFS and OS analysis for this treatment. Hazard ratios (HRs) were calculated from Kaplan-Meier survival curves. Results After propensity matching, 150 patients who underwent HDR brachytherapy (median age, 71 years [IQR, 63-77 years]; 117 males) and 150 patients who underwent TACE (OS analysis median age, 70 years [IQR, 63-77 years]; 119 male; PFS analysis median age, 68 years [IQR: 63-76 years]; 119 male) were analyzed. Hazard of death was higher in the TACE versus HDR brachytherapy group (HR, 4.04; P < .001). Median estimated PFS was 32.8 months (95% CI: 12.5, 58.7) in the HDR brachytherapy group and 11.6 months (95% CI: 4.9, 22.7) in the TACE group. Hazard of disease progression was higher in the TACE versus HDR brachytherapy group (HR, 2.23; P < .001). Conclusion In selected treatment-naive patients with unresectable HCC, treatment with CT-guided HDR brachytherapy led to improved OS and PFS compared with TACE. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Chapiro in this issue.
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