Jang Won Il, Jo Sunmi, Moon Ji Eun, Bae Sun Hyun, Park Hee Chul
Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, 75, Nowon-ro, Nowon-gu, Seoul 01812, Republic of Korea.
Department of Radiation Oncology, Haeundae Paik Hospital, Inje University School of Medicine, 875, Haeun-daero, Haeundae-gu, Busan 48108, Republic of Korea.
Cancers (Basel). 2023 Oct 10;15(20):4914. doi: 10.3390/cancers15204914.
Intensity-modulated radiotherapy (IMRT), an advanced RT technique, is a considerable treatment option for hepatocellular carcinoma (HCC). However, the distinguishing features of IMRT for HCC have not yet been clearly defined. A systematic review was performed according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The PubMed/MedLine, Embase, Cochrane Library, Web of Science, and KoreaMed were used to screen eligible studies focusing on treatment outcomes after IMRT for HCC until 18 April 2023. A total of 1755 HCC patients receiving IMRT among 29 studies from 2009 to 2023 were selected for the meta-analysis. The median proportion of Barcelona Clinic Liver Cancer stage C was 100% (range: 38-100%). Nineteen studies used combined treatment. Pooled rates of response and 1-year local control were 58% (95% confidence interval [CI], 50-65%) and 84% (95% CI, 70-94%), respectively. The median overall survival (OS) was 13 months (range: 5-45 months), and pooled 1- and 3-year OS rates were 59% (95% CI, 52-66%), and 23% (95% CI, 14-33%), respectively. Pooled rates of classic radiation-induced liver disease (RILD), nonclassic RILD, and hepatic toxicity ≥ grade 3 were 2%, 4%, and 4%, respectively. Although most patients had advanced-stage HCC and combined treatment was commonly used, IMRT for HCC showed similar survival to existing RT modalities and relatively low severe toxicity.
调强放射治疗（IMRT）是一种先进的放射治疗技术，是肝细胞癌（HCC）的一种重要治疗选择。然而，IMRT用于HCC的显著特征尚未明确界定。根据系统评价和Meta分析的首选报告项目指南进行了一项系统评价。使用PubMed/MedLine、Embase、Cochrane图书馆、Web of Science和KoreaMed筛选符合条件的研究，这些研究聚焦于截至2023年4月18日IMRT治疗HCC后的治疗结果。从2009年至2023年的29项研究中，共选择了1755例接受IMRT的HCC患者进行Meta分析。巴塞罗那临床肝癌分期C期的中位比例为100%（范围：38 - 100%）。19项研究采用了联合治疗。缓解率和1年局部控制率的合并率分别为58%（95%置信区间[CI]，50 - 65%）和84%（95%CI，70 - 94%）。中位总生存期（OS）为13个月（范围：5 - 45个月），1年和3年OS率的合并率分别为59%（95%CI，52 - 66%）和23%（95%CI，14 - 33%）。经典放射性肝病（RILD）、非经典RILD和≥3级肝毒性的合并率分别为2%、4%和4%。尽管大多数患者患有晚期HCC且联合治疗常用，但IMRT治疗HCC的生存率与现有的放射治疗方式相似，且严重毒性相对较低。
