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Hepatocellular carcinoma: Sorafenib is better than radiotherapy

Anaesthesiology

According to French researchers, Selective internal radiotherapy (SIRT) does not prolong survival compared to sorafenib in patients with advanced hepatocellular carcinoma.

SIRT with yttrium-90 resin microspheres does not prolong survival in patients with advanced hepatocellular carcinoma (HCC) not eligible for curative treatment. "We did observe a better tolerance a better quality of life and a higher tumor control," told by the lead author.

Researchers conducted an open-label phase III trials at 25 centers in patients with hepatocellular carcinoma. The study was published online in The Lancet Oncology. The study included patients aged >18 years with a life expectancy greater than three months.

A total of 467 patients were randomly assigned to receive continuous oral sorafenib or SIRT two to five weeks. Median follow-up was about 28 months. Median overall survival with SIRT (8.0 months, P=0.18) was significantly greater than the 9.9 months seen with sorafenib. In the per-protocol analysis, OS was 9.9 months in both groups.

Researchers said, although there is a survival advantage in the sorafenib group, tolerability was significantly better in the SIRT group. When compared to SIRT the total and median numbers of treatment-related adverse events per patient were twice as frequent with sorafenib. In the sorafenib group, grade 3 or higher treatment-related adverse events were also more frequent.

"Quality of life and tolerance might help when choosing between the two treatments," the team noted. Though SIRT is associated with local efficacy, the only limitation with SIRT is no survival advantage. The approach "should also be evaluated on a large scale in patients with the less advanced disease," Dr. Vilgrain told Reuters Health by email.

"Controlling local tumors in hepatocellular carcinoma is expected to delay liver failure and ultimately improve quality of life and prolong survival. However, the limitations of the study did not allow for a definite conclusion," Dr. Ahmed Omar Kaseb said.