Yang Dae Sik, Park Sunmin, Rim Chai Hong, Yoon Won Sup, Shin In-Soo, Lee Han Ah
Department of Radiation Oncology, Korea University Medical College, Seoul 02841, Korea.
Department of Radiation Oncology, Korea University Guro Hospital, Seoul 08308, Korea.
Medicina (Kaunas). 2021 Sep 22;57(10):1000. doi: 10.3390/medicina57101000.
: Although transarterial chemoembolization (TACE) has been the commonest local modality for hepatocellular carcinoma (HCC), incomplete repsonse occurs especially for tumors with a large size or difficult tumor accessment. The present meta-analysis assessed the efficacy and feasibility of external beam radiotherapy (EBRT) as a salvage modality after incomplete TACE. : We systematically searched the PubMed, Embase, Medline, and Cochrane databases. The primary endpoint was overall survival (OS), and the secondary endpoints included the response ratem toxicity of grade 3, and local control. : Twelve studies involving 757 patients were included; the median of portal vein thrombosis rate was 25%, and the pooled median of tumor size was 5.8 cm. The median prescribed dose ranged from 37.3 to 150 Gy (pooled median: 54 Gy in *EQD2). The pooled one- and two-year OS rates were 72.3% (95% confidence interval (CI): 60.2-81.9%) and 50.5% (95% CI: 35.6-65.4%), respectively; the pooled response and local control rates were 72.2% (95% CI: 65.4-78.1%) and 86.6 (95% CI: 80.1-91.2%) respectively. The pooled rates of grade ≥3 gastrointestinal toxicity, radiation-induced liver disease, hepatotoxicity, and hematotoxicity were 4.1%, 3.5%, 5.7%, and 4.9%, respectively. Local control was not correlated with intrahepatic ( = 0.6341) or extrahepatic recurrences ( = 0.8529) on meta-regression analyses. : EBRT was feasible and efficient in regard to tumor response and control; after incomplete TACE. Out-field recurrence, despite favorable local control, necessitates the combination of EBRT with systemic treatments. *Equivalent dose in 2 Gy per fraction scheme.
尽管经动脉化疗栓塞术（TACE）一直是肝细胞癌（HCC）最常用的局部治疗方式，但尤其是对于大尺寸肿瘤或肿瘤评估困难的情况，会出现不完全反应。本荟萃分析评估了外照射放疗（EBRT）作为TACE不完全反应后的挽救性治疗方式的疗效和可行性。：我们系统检索了PubMed、Embase、Medline和Cochrane数据库。主要终点是总生存期（OS），次要终点包括缓解率、3级毒性和局部控制。：纳入了12项涉及757例患者的研究；门静脉血栓形成率的中位数为25%，肿瘤大小的合并中位数为5.8 cm。规定剂量的中位数范围为37.3至150 Gy（合并中位数：在2 Gy/分次方案中的等效剂量（EQD2）为54 Gy）。1年和2年的合并OS率分别为72.3%（95%置信区间（CI）：60.2 - 81.9%）和50.5%（95% CI：35.6 - 65.4%）；合并缓解率和局部控制率分别为72.2%（95% CI：65.4 - 78.1%）和86.6%（95% CI：80.1 - 91.2%）。≥3级胃肠道毒性、放射性肝病、肝毒性和血液毒性的合并发生率分别为4.1%、3.5%、5.7%和4.9%。在荟萃回归分析中，局部控制与肝内复发（P = 0.6341）或肝外复发（P = 0.8529）无关。：在TACE不完全反应后，EBRT在肿瘤反应和控制方面是可行且有效的。尽管局部控制良好，但野外复发需要将EBRT与全身治疗相结合。*2 Gy/分次方案中的等效剂量
