Dr. Nabavizadeh and his team analyzed data from the United Network for Organ Sharing (UNOS), a non-profit organization that operates the United States transplant system under contract with the federal government, to see which bridging therapies were prescribed most often. Of the 18,477 patients with HCC awaiting transplant since 2013, 85.4% received some type of bridging therapy. However, just 3.6% of those patients were treated with EBRT, either alone (1.2%) or in combination with another type of therapy (2.4%).
Dr. Nabavizadeh said he expected the number to be much higher. “Using our own institutional experience, more than 4% of our patients get EBRT at some point, so 3.6% was a surprising figure to us,” he said, “especially because radiation is the only non-invasive option and has not been shown to be inferior to the other treatments.”
The analysis also found the use of EBRT has increased over the past several years but remains well below utilization for other therapies. TACE was the most utilized therapy, used for 39.6% of patients. Thermal ablation was used for 12.8% of patients, and radioembolization was used for 8.7% of patients. Nearly a quarter of patients (22.2%) received a combination of non-EBRT therapies.
Because there are no data supporting one treatment over another, said Dr. Nabavizadeh, institutional and regional practice patterns are often the key factor driving treatment decisions. Indeed, EBRT usage varied by geographic region, from a high of 8.7% of patients in the Great Lakes states (Michigan, Ohio and Indiana) receiving this type of bridging therapy to a low of 1.7% of patients in the Southeast (Florida, Georgia, Mississippi, Alabama, Louisiana, Arkansas) (p<0.001). EBRT utilization did not differ by clinical parameters such as the number of tumors, tumor diameter or bilirubin levels.
While the study did not explore why patients were prescribed one treatment over another, Dr. Nabavizadeh suggested it could be a result of which type of doctor a patient consulted. “Radiation oncologists are often left out of the management discussions for these patients,” he said. “When presented with choices, many patients want the non-invasive approach. They understand this treatment could really impact their quality of life. Radiation needs to be part of treatment discussions much more frequently than it is now.”
ABOUT ASTRO
The American Society for Radiation Oncology (ASTRO) is the largest radiation oncology society in the world, with nearly 10,000 members who are physicians, nurses, biologists, physicists, radiation therapists, dosimetrists and other health care professionals who specialize in treating patients with radiation therapies.
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