Comparative analysis of stereotactic body radiotherapy (SBRT) vs. SBRT with bridge therapies for hepatocellular carcinoma patients awaiting liver transplantation: A multi-center study (2010-2020).

4143 Background: Locoregional therapies, including SBRT, are essential in managing hepatocellular carcinoma (HCC) patients awaiting liver transplantation. This study evaluates outcomes of SBRT alone versus SBRT combined with other bridge therapies over a 5-year follow-up. Methods: Data from the TriNetX database (2010–2020) were used to compare two matched cohorts: patients receiving SBRT alone and those receiving SBRT with additional bridge therapies, including transarterial chemoembolization (TACE) and radiofrequency ablation (RFA). Patients included were those meeting liver transplant criteria and classified as AJCC Stage I or II. Results: Before matching, the cohorts included 185 patients in the SBRT Alone group and 363 in the SBRT with Other Bridge Therapies group, with significant differences in ethnicity (48.11% vs. 57.3%, p=0.0411) and race (40.54% unknown vs. 31.68%, p=0.0393). After matching (153 patients per group), all variables were balanced, including age (69.4 ± 8.58 vs. 69.1 ± 8.09, p=0.9039) and ethnicity (50.98% vs. 45.75%, p=0.3601). Theoverall survival rate at 5-year follow-up was 61.53% in the SBRT alone group and 62.02% in the SBRT with other therapies group. There was no significant difference between the groups (HR: 0.958, p=0.8417). In the secondary analysis. For acute hepatic failure, the risk was 22.73% for SBRT Alone versus 25.64% for SBRT with Other Bridge Therapies (RR: 0.886, 95% CI: 0.413–1.901, p=0.7567). The risk of decompensated liver disease was 37.74% versus 40% (RR: 0.909, 95% CI: 0.593–1.501, p=0.8054). Procedure-related complications occurred in 11.61% of the SBRT Alone group compared to 12.12% in the other group (RR: 0.958, 95% CI: 0.482–1.904, p=0.9016). Portal vein thrombosis was more frequent in the SBRT Alone group at 12% versus 7.87% (RR: 1.524, 95% CI: 0.712–3.262, p=0.2733). The risk of major adverse cardiovascular events (MACEs) was 24.75% versus 22.12% (RR: 1.158, 95% CI: 0.607–2.213, p=0.6558). Finally, kidney outcomes (acute kidney injury, CKD, ESRD) were similar, with risks of 62.75% and 63.40% (RR: 0.99, 95% CI: 0.834–1.175, p=0.9057). These results suggest no statistically significant differences in the risk of adverse outcomes between the two groups. Conclusions: SBRT alone and SBRT with bridge therapies provide comparable long-term survival outcomes in HCC patients awaiting liver transplantation, with differences in specific complications warranting further study.