Efficacy and safety of stereotactic body radiation therapy combined with transarterial chemoembolization for Chinese intermediate-to advanced-stage hepatocellular carcinoma patients: a systematic review and meta-analysis

Abstract

Aim: According to the current guidelines, transarterial chemoembolization (TACE) remains the first-line therapies for hepatocellular carcinoma (HCC) patients at Barcelona Clinic Liver Cancer (BCLC) B-stage and sorafenib is a small molecule target drug for BCLC C-stage. In clinical practice, clinicians have attempted to use stereotactic body radiation therapy (SBRT) plus TACE for treating intermediate- to advanced-stage HCC. However, the therapeutic effects are still inconsistent. This meta-analysis was conducted to elucidate the validity and safety of the combination therapy of SBRT plus TACE in the patients with intermediate-to advanced-stage HCC.

Methods: PubMed, MEDLINE, Web of Science, China Biology Medicine, Chinese Knowledge resources integrated and Chinese Scientific Journal Full-Text Database was searched from their inception date to November 2018. The survival rates (half-year, one-year and two-year) were analyzed and compared between the observation groups and the control groups. The negative conversion rate of AFP and the total effective rate were also assessed. Risk ratios (RR) and 95%CI were calculated to express therapeutic effects.

Results: A total of 1,210 patients from 13 eligible studies were included. The cooperation of TACE and SBRT notably ameliorated the whole survival rates of half-year, one-year, two-year, the negative conversion rate of AFP, and the total effective rate, compared with TACE or SBRT monotherapy [RR (the total effective rate), 1.412, 95%CI: 1.309-1.523, P < 0.001], [RR (half-year survival rate), 1.196, 95%CI: 1.121-1.276, P < 0.001], [RR (one-year survival rate), 1.327, 95%CI: 1.236-1.424, P < 0.001], [RR (two-year survival rate), 1.479, 95%CI: 1.284-1.703, P < 0.001] and [RR (negative conversion rate of AFP), 1.756, 95%CI: 1.502-2.059, P < 0.001]. Sensitivity analysis supported the above results.

Conclusion: Combination therapy of SBRT and TACE provides survival benefits in intermediate-to advanced-stage HCC patients compared to monotherapy of SBRT or TACE.

Keywords

Transcatheter arterial chemoembolization / hepatocellular carcinoma / stereotactic body radiation therapy / meta-analysis

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