Rim Chai Hong, Kim Chul Yong, Yang Dae Sik, Yoon Won Sup
Department of Radiation Oncology, Ansan Hospital, Korea University Medical College, Ansan, Gyeonggi-do, Republic of Korea,
Department of Radiation Oncology, Anam Hospital, Korea University Medical College, Seoul, Republic of Korea.
Cancer Manag Res. 2018 Sep 6;10:3305-3315. doi: 10.2147/CMAR.S175703. eCollection 2018.
Lymph node metastasis of hepatocellular carcinoma is categorized as advanced in Barcelona Clinic of Liver Cancer staging, and sorafenib is a sole treatment recommended. However, appliance of local treatment including external beam radiotherapy (EBRT) has not been uncommon. We performed a meta-analysis and systemically reviewed current literature to evaluate the efficacy and safety of EBRT.
PubMed, Medline, Cochrane library, and Embase were systemically searched until December 17, 2017. The primary endpoint of analyses was response rate (RR), and 1-year overall survival and complication rates of grade ≥3 were secondary endpoints. Complications were primarily assessed descriptively.
A total of 8 studies comprising 521 patients were included. The pooled RR was 73.1% (95% confidence interval [CI]: 63.6-80.9), and high-dose EBRT groups had better RR than the low-dose group (82.2% [95% CI: 74.4-88.1] vs 51.1% [95% CI: 40.3-61.7]; =0.001]. The pooled 1-year overall survival rate was 41.0% (95% CI: 32.9-49.6). Six studies assessed the survival benefit according to RR, and 5 (83.3%) of these 6 studies reported statistically significant survival benefit. The most common grade ≥3 toxicities were thrombocytopenia and gastrointestinal complication, with pooled rates of 3.4% (95% CI: 1.2-9.5) and 3.5% (95% CI:1.7-7.2), respectively.
EBRT showed a pooled RR of 73.1% and was safely performed. EBRT might palliate symptoms through tumor reductions and improve survival. Use of sorafenib combined or sequentially with EBRT can be recommended rather than monotherapy.
肝细胞癌的淋巴结转移在巴塞罗那肝癌临床分期中被归类为晚期，索拉非尼是唯一推荐的治疗方法。然而，包括外照射放疗（EBRT）在内的局部治疗的应用并不罕见。我们进行了一项荟萃分析并系统回顾了当前文献，以评估EBRT的疗效和安全性。
系统检索了截至2017年12月17日的PubMed、Medline、Cochrane图书馆和Embase。分析的主要终点是缓解率（RR），1年总生存率和≥3级并发症发生率为次要终点。主要对并发症进行描述性评估。
共纳入8项研究，包括521例患者。汇总RR为73.1%（95%置信区间[CI]：63.6 - 80.9），高剂量EBRT组的RR优于低剂量组（82.2%[95%CI：74.4 - 88.1]对51.1%[95%CI：40.3 - 61.7]；P = 0.001）。汇总的1年总生存率为41.0%（95%CI：32.9 - 49.6）。6项研究根据RR评估了生存获益，这6项研究中有5项（83.3%）报告了具有统计学意义的生存获益。最常见的≥3级毒性是血小板减少症和胃肠道并发症，汇总发生率分别为3.4%（95%CI：1.2 - 9.5）和3.5%（95%CI：1.7 - 7.2）。
EBRT显示汇总RR为73.1%，且实施安全。EBRT可能通过缩小肿瘤缓解症状并改善生存。推荐索拉非尼与EBRT联合或序贯使用，而非单一疗法。
