Potentially curative treatments for early-stage
hepatocellular carcinoma (HCC) have drawbacks and
contraindications. Recently,
radiotherapy has achieved good outcomes. We compared the outcomes of
radiotherapy and
radiofrequency ablation (RFA) for early-stage HCC. Consecutive patients with ≤3 early-stage HCC lesions and
tumor diameters ≤3 cm treated with RFA or
radiotherapy were reviewed. RFA was the first choice for HCC unsuitable for surgery. Otherwise, stereotactic body radiotherapy in five fractions was mainly performed. For HCC adjacent to the gastrointestinal tract,
radiotherapy with mild hypofractionation was performed. Propensity score matching was performed to reduce the selection bias between the RFA and
radiotherapy groups. Between 2012 and 2016, a total of 231 patients with 474
tumors and 143 patients with 221
tumors were eligible and were treated with RFA and
radiotherapy, respectively. In an unmatched comparison, the 3-year local recurrence rate was significantly lower for
radiotherapy than for RFA (5.3%; 95% confidence interval [CI], 2.7-9.2; versus 12.9%, 95% CI, 9.9-16.2) (P < 0.01). A propensity score matching analysis of 106 patients in each group successfully matched the two treatment groups with regard to Barcelona Clinic
Liver Cancer staging, T stage, and
tumor size but not the adjacency of the
tumor to risk organs or first or
salvage treatment. The 3-year overall survival rates for RFA and
radiotherapy patients were comparable (69.1%; 95% CI, 58.2-77.7; and 70.4%; 95% CI, 58.5-79.4, respectively; P = 0.86). Conclusion:
Radiotherapy has excellent local control and comparable overall survival in patients with well-compensated liver function, exhibiting advantageous characteristics and compensating for the deficiencies of other treatment modalities;
radiotherapy appears to be an acceptable alternative treatment option for patients who are not candidates for RFA.