The role of external beam radiotherapy for hepatocellular carcinoma patients with lymph node metastasis: a meta-analysis of observational studies
Authors Rim CH, Kim CY, Yang DS, Yoon WS
Received 29 May 2018
Accepted for publication 30 June 2018
Published 6 September 2018 Volume 2018:10 Pages 3305—3315
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Cristina Weinberg
Peer reviewer comments 2
Editor who approved publication: Professor Nakshatri
Chai Hong Rim,1 Chul Yong Kim,2 Dae Sik Yang,3 Won Sup Yoon1
1Department of Radiation Oncology, Ansan Hospital, Korea University Medical College, Ansan, Gyeonggi-do, Republic of Korea; 2Department of Radiation Oncology, Anam Hospital, Korea University Medical College, Seoul, Republic of Korea; 3Department of Radiation Oncology, Guro Hospital, Korea University Medical College, Seoul, Republic of Korea
Purpose: 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.
Methods: 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.
Results: 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]; P=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.
Conclusion: 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.
Keywords: hepatocellular carcinoma, lymph node metastasis, meta-analysis, radiation therapy
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