Kuehnle Ryan A, Tchelebi Leila T, Ludmir Ethan B, Escorcia Freddy E, Shrestha Sabi, Sanford Nina, Court Colin M, Ryckman Jeff M, Arora Sukeshi P, Lehrer Eric J, Gelfond Jonathan, Jethwa Krishan R, Newman Neil B
Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
Northwell, New Hyde Park, New York, USA.
Cancer. 2025 Feb 1;131(3):e35720. doi: 10.1002/cncr.35720.
External-beam radiation (EBRT) is a noninvasive therapeutic alternative to transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). The objective of this study was to conduct a systematic review and meta-analysis of prospective randomized clinical trials to assess the clinical efficacy of EBRT versus TACE for HCC as either a definitive monotherapy or as a bridge to transplantation/surgery.
A systematic review and meta-analysis were performed to include prospective randomized trials comparing EBRT versus TACE. Data was analyzed with random and fixed-effects models. The inconsistency index (I) was chosen to assess heterogeneity. Three publications were included with a total of 142 patients. Outcomes included local control (LC), overall survival (OS), progression-free survival (PFS), and occurrences of grade ≥3 toxicity. Comparisons are reported as hazard ratios (HRs) or risk ratios (RRs) with 95% confidence intervals (CIs).
There were three randomized trials that met inclusion criteria. The EBRT was delivered in three to 15 fractions with a total dose between 30 and 75 gray(Gy). EBRT was associated with significantly improved LC (HR, 0.16; 95% CI, 0.08-0.34; I = 0%) and PFS (HR, 0.37; 95% CI, 0.23-0.60; I, 0%) compared with TACE. There was no significant difference between EBRT and TACE in OS (RR, 0.79; 95% CI, 0.51-1.22; I = 0%) or grade ≥3 toxicity (RR, 0.86; 95% CI, 0.31-2.37; I = 57%). None of the analyses had statistically significant heterogeneity.
Compared with TACE, EBRT yields superior LC and PFS without providing a survival benefit in early and intermediate stage HCC. Additional larger prospective randomized controlled trials should be conducted to further investigate differences in clinical outcomes amongst patients with more advanced disease.
