Department of Radiation Oncology, Ansan Hospital, Korea University Medical College, Ansan, Gyeonggi-do, Republic of Korea.
Department of Radiation Oncology, Korea University Medical College, Seoul, Korea.
Int J Radiat Biol. 2023;99(3):419-430. doi: 10.1080/09553002.2022.2094020. Epub 2022 Aug 8.
External beam radiation therapy (EBRT) is commonly used as a palliative treatment for bone metastases of hepatocellular carcinoma (HCC). We planned a hybrid systematic review that meta-analyzed the efficacy and feasibility of EBRT and reviewed the literature to answer specific clinical questions.
The PubMed, Medline, Embase, and Cochrane Library databases were searched through 1 December 2021. Primary endpoints were overall survival (OS) and response rate (RR). Secondary endpoints were comparative data, including treatment response and survival related to dose escalation, number of metastases, and fractionation scheme. Formal pooled analyses were performed on the primary endpoints, and the secondary endpoints were systematically reviewed. Complications were also reviewed.
Nineteen studies involving 1613 patients with HCC and bone metastases were included. The median OS was 6 months (range: 3-13 months). The pooled one-year OS was 23.1% (95% confidence interval [CI]: 18.4-28.6); pooled pain RR was 81.5% (95% CI: 76.4-85.7) and of pain complete remission was 26.5% (95% CI: 21.7-32.0). Pain response might be related to dose escalation, considering the moderate consistency of results and plausibility, with a low-quality grade of evidence. Considering the indeterminate results, we cannot suggest that dose escalation is correlated with OS. The oligometastasis status might be related to better OS, considering the high consistency of results and plausibility with low to moderate quality of evidence. Hypofractionated EBRT might yield comparable efficacy to conventional EBRT, with a low-quality grade of evidence. There were few complications of grade ≥3, except for hematologic complications, which ranged from 11.5to 34%.
EBRT is an efficient and feasible palliative option. Clinical consideration of hematologic complications is necessary. Future studies are needed to increase the quality of evidence for actual clinical questions. Reference to a system of the American Society for Radiation Oncology primary liver cancer clinical guidelines.
外照射放疗（EBRT）通常被用作肝细胞癌（HCC）骨转移的姑息性治疗方法。我们计划进行一项混合系统评价，对 EBRT 的疗效和可行性进行荟萃分析，并对文献进行回顾，以回答具体的临床问题。
通过 2021 年 12 月 1 日检索 PubMed、Medline、Embase 和 Cochrane 图书馆数据库。主要终点是总生存期（OS）和反应率（RR）。次要终点是包括剂量递增、转移灶数量和分割方案与治疗反应和生存相关的比较数据。对主要终点进行了正式的汇总分析，并对次要终点进行了系统回顾。还回顾了并发症。
共纳入 19 项研究，涉及 1613 例 HCC 和骨转移患者。中位 OS 为 6 个月（范围：3-13 个月）。汇总的一年 OS 为 23.1%（95%置信区间[CI]：18.4-28.6）；汇总的疼痛 RR 为 81.5%（95% CI：76.4-85.7），疼痛完全缓解率为 26.5%（95% CI：21.7-32.0）。考虑到结果的中度一致性和合理性，疼痛反应可能与剂量递增有关，但证据质量为低级别。考虑到不确定的结果，我们不能认为剂量递增与 OS 相关。寡转移状态可能与更好的 OS 相关，考虑到结果的高度一致性和合理性，证据质量为低到中级。低分割 EBRT 可能与常规 EBRT 具有相当的疗效，证据质量为低级别。除血液学并发症外，≥3 级的并发症很少，范围为 11.5 至 34%。
EBRT 是一种有效的、可行的姑息治疗选择。需要考虑血液学并发症的临床问题。未来需要进行更多的研究，以提高实际临床问题的证据质量。参考美国放射肿瘤学会原发性肝癌临床指南系统。
