Radiofrequency ablation and stereotactic body radiotherapy for hepatocellular carcinoma: should they clash or reconcile?

Abstract

Until a few decades ago, surgical resection was the only valid option for treating hepatocellular carcinoma (HCC). However, various locoregional modalities including arterial-directed therapy, radiofrequency ablation (RFA), and radiotherapy have been recently shown to be effective. RFA is now established as a standard treatment for small localized HCCs, showing oncological results comparable to those of surgical resection in randomized studies. Stereotactic body radiotherapy (SBRT) is a modern radiotherapeutic modality that targets tumors with precision and delivers high radiation doses over a short period of time; it has particularly attracted clinical interest after its therapeutic efficacy was found to be similar to that of surgery in early-stage lung cancer. Given its potent disease control capability, SBRT has also been applied to early HCCs and demonstrated promising results in recent studies. It has also been noted for its suitability to treat tumors located in anatomical locations where RFA would be challenging. However, since its effectiveness has not been compared to that of RFA in randomized studies of patients eligible for RFA, the use of SBRT has been debated. This review was conducted to guide physicians from all fields involved in the treatment of early HCC. The therapeutic characteristics and indications of both SBRT and RFA are described, and recent comparative studies between the two modalities are discussed. In addition, we examined the factors that should be considered when selecting the appropriate treatments, and offer our recommendations.

Keywords:

• Radiofrequency ablation
• stereotactic body radiotherapy
• hepatocellular carcinoma
• liver neoplasm
• stereotactic ablative body radiotherapy
• comparative studies

Author contributions

CH Rim: drafting, conceptualization, supervision, HY Lee: editing, supervision; JS Kim: editing and supervision.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The present research was financially supported by the National Research Fund of Korea [NRF-2019M2D2A1A01031560]. The research grant supported only methodological aspects including statistical analysis and linguistic correction and did not affect major contents including the results and conclusions.

Notes on contributors

Chai Hong Rim

Chai Hong Rim is a radiation oncologist with 15 years of experience and is also a passionate researcher. He is the senior author of 40 peer-reviewed articles published in the last three years; his research specialty includes radiotherapy for liver and lung cancer as well as clinical decision-making on intractable cancer cases.

Hye Yoon Lee

Hye Yoon Lee is a professor and chief surgical oncologist at the Korea University Medical Center. She shared her surgical expertise in drafting the present article.

Jung Sun Kim

Jung Sun Kim is a professor and chief medical oncologist at the Korea University Medical Center. She shared her perspective as a medical oncologist for the present article.

Hakyoung Kim

Hakyoung Kim is a radiation oncologist and junior professor at Korea University Medical Center.