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Updated: Aug 6, 2026
Treatment of Liver Metastases Using an Internal Target Volume Method for Stereotactic Body Radiotherapy
Published on: May 8, 2018
Integrated Evaluation of Survival, Surgical Conversion, and Toxicity for Induction Therapy in Initially Unresectable
Guilin Nie1,2, Xinming Li1,2, Yaoqun Wang1,2
1Division of Biliary Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Background:
Patients with initially unresectable colorectal cancer liver metastases (CRLM) could derive benefits from active induction regimens by increasing the likelihood of surgical conversion. However, the comparative benefit-risk profiles of currently available regimens remain unclear. We performed an individual patient data (IPD) and network meta-analysis (NMA) to compare the efficacy of active induction regimens.
Patients And Methods:
IPD was reconstructed from randomized controlled trials (RCTs). The primary outcome was progression-free survival (PFS). Secondary outcomes included R0-1 resection rate, overall survival (OS), and grade ≥ 3 adverse events (AEs). Subgroup analyses were conducted according to KRAS/BRAF status and primary tumor sidedness. An entropy-weighted TOPSIS model was used to integrate efficacy and safety outcomes.
Results:
Seven RCTs involving 1368 patients were included. IPD-based network analysis suggested that bevacizumab + triplet-chemotherapy was associated with the highest probability of improving R0-1 resection rate (0.99) and prolonging PFS (0.99). No significant differences in OS were observed among targeted therapy-based regimens. For patients with KRAS/BRAF wild-type tumors, cetuximab + doublet-chemotherapy is the only therapy performed better than chemotherapy in prolonging PFS. Bevacizumab + triplet-chemotherapy demonstrated superior efficacy among patients with KRAS/BRAF-mutant tumors. No significant PFS differences were observed among therapies in both left-sided and right-sided. Bevacizumab + doublet-chemotherapy demonstrated a more balanced benefit-risk profile with the highest Topsis scores (0.67).
Conclusions:
Bevacizumab plus triplet chemotherapy improves disease control and surgical conversion benefits but is associated with greater toxicity. Bevacizumab plus doublet chemotherapy showed the most favorable benefit-risk balance and may represent an optimal compromise for patients with initially unresectable CRLM.
