In this prospective randomized clinical trial, the efficacy and safety of treating hepatocellular carcinoma (HCC) with either radiofrequency ablation (RFA) or stereotactic body radiation therapy (SBRT) was compared. Patients (n-166) with small HCC (≤ 5 cm), with good performance status and controlled disease were randomized. The prescription dose was 36-54 Gy in 3 fractions delivered every other day over 1 week. Patients in the RFA arm were allowed to have a second RFA if there was residual tumor detected 1 month after the initial procedure. The primary endpoint was local progression free survival (LPFS); secondary endpoints included progression free survival (PFS), overall survival (OS), local control rate (LCR), and safety/toxicity.

At a median follow-up of about 43 months, SBRT demonstrated better LPFS than RFA (HR 0.45, p = 0.014) for both larger tumors and for tumors ≤ 2 cm. LCR was also superior with SBRT. PFS, OS, and acute and late toxicity were not significantly different between groups. Thus, this randomized clinical trial demonstrated that both methods are safe and effective, although SBRT provided better local control.

Reference (Pub-Med Link): Xi M, Yang Z, Hu L, et al. Radiofrequency ablation versus stereotactic body radiotherapy for recurrent small hepatocellular carcinoma: A randomized, open-label, controlled trial. J Clin Oncol 2025;43:1073-1082. https://doi.org/10.1200/jco-24-01532

Key Institution: Sun Yat-sen University Cancer Center

Keywords: Liver Cancer