The role of external beam radiotherapy for hepatocellular carcinoma patients with lymph node metastasis: a meta-analysis of observational studies
- Authors
- Rim, Chai Hong; Kim, Chul Yong; Yang, Dae Sik; Yoon, Won Sup
- Issue Date
- 2018
- Publisher
- DOVE MEDICAL PRESS LTD
- Keywords
- hepatocellular carcinoma; lymph node metastasis; meta-analysis; radiation therapy
- Citation
- CANCER MANAGEMENT AND RESEARCH, v.10, pp.3305 - 3315
- Indexed
- SCIE
SCOPUS
- Journal Title
- CANCER MANAGEMENT AND RESEARCH
- Volume
- 10
- Start Page
- 3305
- End Page
- 3315
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/81020
- DOI
- 10.2147/CMAR.S175703
- ISSN
- 1179-1322
- Abstract
- 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.
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