Proton beam therapy versus trans-arterial chemoembolization for BCLC stage B hepatocellular...

Proton beam therapy (PBT) has a promising local control rate, but clinical data supporting its use for intermediate-stage hepatocellular carcinoma (HCC) remains insufficient, and its survival benefit over transarterial chemoembolization (TACE) has yet to be established. This study aimed to compare the two modalities by evaluating real-world survival outcomes.

The propensity score-matched (PSM) cohort study used data from a multi-institutional medical research database. Treatment-naïve patients with Barcelona Clinic Liver Cancer (BCLC) stage B HCC who underwent PBT or TACE as monotherapy were enrolled. Baseline patient and tumor characteristics were used for matching. Overall survival (OS) and post-treatment albumin-bilirubin (ALBI) grade were assessed, and stratified analyses were performed to evaluate the heterogeneity.

Between January 2007 and December 2022, 4349 patients with BCLC‑B HCC were identified, 1172 of whom met the inclusion criteria (PBT: 68; TACE: 1104). The PSM cohort matched 340 patients (PBT: 68; TACE: 272). Cox regression analysis revealed a significant survival benefit in the PBT group (p = 0.032, hazard ratio (HR) 0.64, 95% CI 0.42-0.97). Liver function was assessed in terms of ALBI grade every 3 months for 12 months after treatment, and the proportion of patients who maintained better liver function was greater in the PBT group than in the TACE group (p = 0.006).

For patients with BCLC‑B HCC who are suitable candidates for PBT, PBT preserves better liver function than TACE and provides superior OS.