ArticleJHEP reports : innovation in hepatology2026
Irreversible electroporation vs. stereotactic body radiotherapy for solitary hepatocellular carcinoma ≤5 cm: A multicenter retrospective study.
Article in JHEP reports : innovation in hepatology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND &
aimsIrreversible electroporation (IRE) and stereotactic body radiotherapy (SBRT) are important therapeutic alternatives for hepatocellular carcinoma (HCC) unsuitable for thermal ablation, but comparative outcome data remain limited. We compared the efficacy and safety of IRE vs. SBRT for solitary HCC ≤5.0 cm.
methodsBetween January 2019 and December 2024, this multicenter retrospective cohort study at five centers included 315 patients with solitary HCC ≤5.0 cm (IRE, n = 180; SBRT, n = 135). To reduce confounding, propensity score matching (PSM), inverse probability of treatment weighting (IPTW), and restricted cubic splines (RCS) were applied. The primary endpoint was cumulative recurrence rate (CRR), comprising cumulative local recurrence (CLRR) and cumulative distant recurrence (CDRR). Secondary endpoints included progression-free survival (PFS), overall survival (OS), and adverse events (AEs).
resultsAfter a median follow-up of 36 months, matched cohorts showed no significant differences in CRR (hazard ratio [HR]: 0.83; p = 0.332), PFS (HR: 0.77; p = 0.171), or OS (HR: 0.76; p = 0.529). However, in the matched cohort, IRE achieved superior local control, with a lower 3-year CLRR (14.2% vs. 30.5%; HR: 0.31; p = 0.001). SBRT local control was lower than in some previous studies, possibly reflecting anatomically complex tumors requiring risk-adapted planning. This CLRR benefit was consistent across tumor sizes and in perivascular HCC. CDRR was comparable (HR: 0.92; p = 0.685). Overall AE rates were similar (33.3% vs. 38.5%; p = 0.266), although profiles differed (transaminase elevations with IRE vs. gastrointestinal disturbances with SBRT).
conclusionsIRE and SBRT yielded comparable OS and PFS for solitary HCC ≤5.0 cm. However, IRE offered significantly superior local tumor control, especially for tumors adjacent to major vessels. IMPACT AND IMPLICATIONS: This multicenter study addresses the limited comparative evidence between IRE and SBRT for HCC unsuitable for thermal ablation. The findings indicate that, although survival outcomes were comparable, IRE demonstrated superior local tumor control, particularly for perivascular lesions. These results support IRE as a strategic therapeutic option for anatomically complex tumors, aiding clinicians in optimizing treatment selection based on specific tumor location and vascular proximity. Future prospective trials are warranted to validate these findings and refine patient selection.
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