External beam radiotherapy for unresectable hepatocellular carcinoma
Omar Abdel-Rahman1, Zeinab Elsayed1
1Clinical Oncology, Faculty of Medicine, Ain Shams University, Lofty Elsayed Street, Cairo, Egypt, 11335.
The Cochrane Database of Systematic Reviews
|March 8, 2017
Summary
External beam radiotherapy combined with chemoembolisation may reduce mortality and improve response rates for unresectable hepatocellular carcinoma. However, evidence quality is low, and combined treatment increases toxicity, necessitating cautious interpretation and further high-quality trials.
Area of Science:
- Hepatobiliary Oncology
- Radiation Oncology
- Clinical Trial Methodology
Background:
- Hepatocellular carcinoma (HCC) is a leading cause of cancer mortality globally, with increasing incidence.
- Curative treatments like resection and transplantation benefit only a minority of early-stage HCC patients.
- Management of unresectable HCC relies on therapies such as chemoembolisation and systemic drugs.
Purpose of the Study:
- To evaluate the efficacy and safety of external beam radiotherapy (EBRT) in treating localized unresectable HCC.
- To synthesize evidence from randomized clinical trials comparing EBRT-based treatments with other interventions.
Main Methods:
- Systematic search of multiple databases (Cochrane, MEDLINE, Embase, Web of Science, clinicaltrials.gov) up to October 2016.
- Inclusion of randomized clinical trials comparing EBRT (monotherapy or combination) against placebo, no treatment, or other therapies.
- Meta-analysis using fixed-effect and random-effects models, with risk of bias assessment (Cochrane methodology) and Trial Sequential Analysis.
Main Results:
- Nine trials (879 participants) met inclusion criteria; all had high risk of bias, yielding low to very low-quality evidence.
- Combined EBRT and chemoembolisation showed a potential reduction in one-year all-cause mortality (RR 0.51) and increased response rates (complete response RR 2.14, overall response RR 1.58) versus chemoembolisation alone.
- Combined treatment was associated with increased toxicity, specifically elevated bilirubin (RR 2.69) and alanine aminotransferase (RR 1.41).
Conclusions:
- Low-quality evidence suggests potential benefits of combined EBRT and chemoembolisation for unresectable HCC, including reduced mortality and improved response rates.
- Significant toxicities (elevated liver enzymes, bilirubin) were observed with the combined approach.
- High risk of bias, imprecision, and inconsistency necessitate cautious interpretation; high-quality trials are crucial for definitive assessment.
