Stereotactic body radiotherapy versus hepatic resection for recurrent small hepatocellular carcinoma: A post-hoc analysis with propensity score adjustment from two randomized trials.

[BACKGROUND] Stereotactic body radiotherapy (SBRT) has been proven effective for treating small hepatocellular carcinoma (sHCC); however, the comparative efficacy of SBRT and surgical resection remains unknown. This analysis aims to compare the outcomes of SBRT and resection in treating recurrent sHCC.

[METHODS] Two randomized controlled trials enrolled recurrent sHCC undergoing resection (NCT01833286) or SBRT (NCT04047173). Patients with single recurrent HCC ≤ 5 cm were included in this study. The primary endpoint was local progression-free survival (LPFS).

[RESULTS] A total of 158 patients were included, with 83 and 75 patients assigned to the SBRT and resection cohorts, respectively. The cumulative 3-year LPFS rates were 84.3% (95% CI, 76.1-92.5) with SBRT and 76.8% (95% CI, 67.2-86.4) with resection, respectively (HR, 0.70 [95% CI, 0.35-1.40]; P = 0.311). The median progression-free survival time of the SBRT and resection group was 37.6 (95% CI, 26.0-49.2) and 26.3 (95% CI, 18.8-33.8) months, respectively, with no significant differences (HR, 0.80 [95% CI, 0.53-1.21]; P = 0.287). The 3-year overall survival rates were 90.3% (95% CI, 83.4-97.2) in the SBRT group, and 81.1% (95% CI, 76.5-90.1) in the resection group (HR, 0.53 [95% CI, 0.23-1.20]; P = 0.118). The comparison results remained consistent after adjusting for confounding variables. The incidences of adverse events were similar between the two groups (P = 0.695).

[CONCLUSIONS] SBRT provides satisfactory tumor control and long-term outcomes, comparable to those of resection. SBRT could be a potential alternative to resection in recurrent sHCC.