我们的目的是调查对于接受酪氨酸激酶抑制剂 (TKI) 治疗的晚期肝细胞癌 (HCC) 患者来说，同时使用肝内外照射放疗 (EBRT) 是否是一个可行的选择。巴塞罗那临床总共 453 名肝癌 C 期患者 (对开始一线 TKI 联合肝内 EBRT 治疗（TKI RT，n = 97）或 TKI 不联合肝内 EBRT（TKI，n = 356）的 HCC 进行分析。比较总体队列、接受至少 8 周 TKI 治疗的患者和倾向评分匹配队列的总生存期 (OS) 和无进展生存期 (PFS)。接受 TKI RT 治疗的患者的 OS 和 PFS 更好比 TKI 长（分别为 8.6 个月与 4.4 个月和 4.5 个月与 2.3 个月，p < 0.001）。值得注意的是，TKI RT 组表现出肝内肿瘤进展的时间明显更长。在亚组分析中，所有亚组中 TKI RT 的 OS 均优于 TKI，并且无肝外转移和门静脉侵犯患者的 PFS 显着改善。 TKI RT 组和 TKI 组之间因不良事件而停止治疗的情况没有显着差异（32.0% vs. 37.9%，p = 0.34）。此外，与不进行肝内 EBRT 的 TKI 治疗相比，接受 TKI RT 治疗的患者随着时间的推移显示出更好的肝功能保存。在接受至少 8 周 TKI 治疗的患者和倾向评分匹配队列之间观察到了可比较的治疗结果。针对肝脏和/或大血管侵犯的同步肝内 EBRT 可能是改善接受 TKI 的 BCLC C 期患者预后的可行选择旨在控制肝内进展并保留肝功能的治疗。© 2023 作者。由巴塞尔 S. Karger AG 出版。

We aimed to investigate whether concurrent use of intrahepatic external beam radiotherapy (EBRT) is a viable option for patients with advanced hepatocellular carcinoma (HCC) undergoing tyrosine kinase inhibitor (TKI) therapy.A total of 453 patients with Barcelona Clinic Liver Cancer stage C (BCLC C) HCC, who started first-line treatment with TKI with intrahepatic EBRT (TKI + RT, n = 97) or TKI without intrahepatic EBRT (TKI, n = 356) were analyzed. The overall survival (OS) and progression-free survival (PFS) were compared in the overall cohort, patients who received at least 8 weeks of TKI treatment and a propensity score-matched cohort.OS and PFS were better in those treated with TKI + RT than TKI (8.6 vs. 4.4 months and 4.5 vs. 2.3 months, respectively, with p < 0.001). Of note, the TKI + RT group demonstrated significantly longer time to intrahepatic tumor progression. In subgroup analysis, TKI + RT led to better OS than TKI in all subgroups and PFS was significantly improved in patients without extrahepatic metastasis and those with portal vein invasion. There was no significant difference in treatment discontinuation due to adverse events between the TKI + RT and TKI groups (32.0% vs. 37.9%, p = 0.34). Furthermore, patients treated with TKI + RT showed better liver function preservation over time compared to TKI without intrahepatic EBRT. Comparable treatment outcomes were observed between patients who received at least 8 weeks of TKI treatment and the propensity score-matched cohort.Concurrent intrahepatic EBRT targeting the liver and/or macrovascular invasion can be a viable option to improve outcomes of BCLC stage C patients receiving TKI therapy with an aim to control intrahepatic progression and preserving the liver function.© 2023 The Author(s). Published by S. Karger AG, Basel.