Hepatocellular carcinoma (HCC) that cannot be surgically removed presents significant treatment challenges. While CT-guided high-dose-rate (HDR) brachytherapy has emerged as a promising option, direct comparisons with other standard treatments like transarterial chemoembolization (TACE) have been limited. This study investigates and compares the outcomes of CT-guided HDR brachytherapy versus TACE in patients with unresectable HCC.
This retrospective, multi-institutional study rigorously analyzed data from a cohort of treatment-naive patients diagnosed with unresectable HCC. These patients consecutively underwent either CT-guided HDR brachytherapy or TACE between January 2010 and December 2022. To mitigate bias and ensure a robust comparison, patient cohorts were meticulously matched based on crucial clinical and tumor characteristics. Propensity score matching was employed to create comparable groups, allowing for a more accurate assessment of treatment effectiveness.
The core findings of this research underscored the notable efficacy of CT-guided HDR brachytherapy. Patients who received CT-guided HDR brachytherapy exhibited a statistically significant improvement in overall survival (OS) when juxtaposed with the TACE treatment group (Hazard Ratio [HR], 4.04; P < .001). Furthermore, the median progression-free survival (PFS), a critical measure of treatment durability, was markedly extended in the CT-guided HDR brachytherapy cohort. These patients experienced a median PFS of 32.8 months, a considerable extension compared to the 11.6 months observed in the TACE cohort (HR, 2.23; P < .001).
The results of this comparative study indicate that CT-guided HDR brachytherapy offers a significant improvement in both overall survival and progression-free survival for carefully selected, treatment-naive patients with unresectable hepatocellular carcinoma when compared to TACE. This suggests that CT-guided HDR brachytherapy may be a superior treatment option for this patient population.
