Lenvatinib in combination with radiotherapy versus lenvatinib with transarterial chemoembolization for advanced hepatocellular carcinoma.
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BACKGROUND: This study aimed to evaluate the efficacy of lenvatinib combined with either radiotherapy (RT) or transarterial chemoembolization (TACE) in patients with advanced hepatocellular carcinoma (HCC). METHODS: Conducted between December 2018 and January 2022, this retrospective study included 32 patients with advanced HCC from a single institution. The patients were divided into two treatment groups: RT plus lenvatinib (n = 17) and TACE plus lenvatinib (n = 15). The primary outcomes assessed were overall survival (OS) and infield control (IFC). Treatment modalities, patient demographics, disease characteristics, and therapeutic responses were analyzed using the Kaplan-Meier method and Cox regression models to identify predictors of OS and IFC. To address baseline imbalances and competing risks, inverse-probability-of-treatment weighting (IPTW) and Fine-Gray analyses were applied to better estimate IFC outcomes. RESULTS: With a median follow-up of 10.2 months, no significant difference in OS was observed between the RT and TACE groups. However, the Kaplan-Meier analysis indicated significantly longer IFC durations in the RT group (p = 0.010), with a 1-year IFC rate of 74.7% compared to 13.2% in the TACE group. Multivariable analysis further demonstrated that the RT group was associated with better IFC outcomes (p = 0.023). After IPTW adjustment, the RT group retained a significant IFC benefit (p = 0.020). At 12 months, the cumulative infield failure rate was 61.0% in the TACE group versus 14.9% in the RT group (p = 0.015). Alpha-fetoprotein levels significantly declined within 3 months after RT (p = 0.002) but not after TACE (p = 0.510). A ≥ 2-point deterioration in the Child-Pugh score was observed in 5.9% of the RT group when compared to 26.7% of the TACE group (p = 0.161). CONCLUSION: These findings suggest that RT combined with lenvatinib may offer advantages in local tumor control and potentially liver function preservation, providing a promising alternative for patients with advanced HCC.