Comparative research on the efficacy of CyberKnife® and surgical excision for Stage I hepatocellular carcinoma

OBJECTIVE To retrospectively analyze and compare the outcomes of patients with hepatocellular carcinoma treated with either surgical excision or CyberKnife® from September 2006 to August 2011. MATERIALS AND METHODS Local control and toxicity were the primary endpoints, followed by local progression-free survival, progression-free survival, and overall survival as the secondary endpoints. Response Evaluation Criteria In Solid Tumors were the evaluation criteria for efficacy; Common Toxicity Criteria 3.0 were the evaluation criteria for adverse events. Local control was calculated using the direct method (nonactuarial). The survival curves were drawn using the Kaplan-Meier method along with log-rank test analysis. RESULTS The research included 26 patients treated with tumor-free cutting edge (R0) surgical excision and 22 patients treated with CyberKnife treatment. The results showed that the adverse effects of CyberKnife were milder, with 1-, 2-, and 3-year local control rates of 92.9%, 90.0%, and 67.7%, respectively. The overall survival rates of the surgical treatment were 88.5%, 73.1%, and 69.2% for the same periods, while those of CyberKnife treatment were 72.7%, 66.7%, and 57.1%, respectively. In this study, surgical excision appeared to prolong overall survival to a greater extent, but with no statistical significance; no statistical difference was observed in the tumor-specific overall survival and progression-free survival between the two cohorts. CONCLUSION According to this preliminary study, with its mild toxicity, the efficacy of CyberKnife treatment for early hepatocellular carcinoma was on par with that of surgical resection.