Comparison of radiation therapy modalities for hepatocellular carcinoma with portal vein thrombosis: A meta-analysis and systematic review

Rim, Chai Hong; Kim, Chul Yong; Yang, Dae Sik; Yoon, Won Sup

doi:10.1016/j.radonc.2017.11.013

Cited by 88 publications

(69 citation statements)

References 84 publications

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“…In comparison to 3DCRT and TARE, a meta-analysis of 2,513 patients found 1-year survival among the three treatment methodologies were comparable (43.8-48.5%), but pooled local control rates were significantly higher with SBRT (86.9%) and 3DCRT (82.8%) compared with TARE (57.5%). 76 In addition, SBRT was found to relieve abdominal discomfort and distension in as many as 69% of patients. 77 No randomized trials have been completed comparing SBRT with transarterial therapies in patients with vascular invasion.…”

Section: Advanced Stage With Pvtmentioning

confidence: 99%

“…[79][80][81] However, several randomized trials comparing sorafenib with or without SBRT (RTOG 1112, NCT01730937) or with or without TACE (NCT01906216, NCT01829035) are ongoing. As SBRT produces significantly higher local control rates compared with TARE, 76 we hope some of these clinical trials will provide additional data supporting local or regional therapy for patients with unresectable locally advanced HCC. Further studies will be needed to compare modalities as monotherapy or combined therapy.…”

Section: Advanced Stage With Pvtmentioning

confidence: 99%

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Radiation Therapy in HCC: What Data Exist and What Data Do We Need to Incorporate into Guidelines?

Feng

2018

Semin Liver Dis

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Hepatocellular carcinoma (HCC) is a complex and diverse disease, with choice of treatment dependent on a patient's disease burden, location of disease, underlying liver function, and performance status. While radiation therapy (RT) was historically omitted from treatment algorithms, immense technological advances over the past several decades have enabled introduction of RT as an effective and safe treatment option for patients with HCC. Growing prospective and retrospective evidence supports the use of RT, particularly stereotactic body radiotherapy (SBRT), for a wide range of indications in HCC from locally advanced unresectable disease to bridge therapy for liver transplant candidates. SBRT is associated with excellent local control, even for patients refractory to or ineligible for other forms of locoregional therapy. Treatment is well-tolerated and associated with low rates of severe toxicity. Randomized trials are needed to define the role of SBRT in HCC treatment relative to other established locoregional treatments.

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Section: Advanced Stage With Pvtmentioning

confidence: 99%

Section: Advanced Stage With Pvtmentioning

confidence: 99%

Radiation Therapy in HCC: What Data Exist and What Data Do We Need to Incorporate into Guidelines?

Feng

2018

Semin Liver Dis

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“…In addition, the survival benefits were not significant in patients with extrahepatic metastases in previous landmark trials . Local treatment using EBRT has been commonly performed, especially for patients with portal invasion . Yoon et al designed and performed the first meaningful RCT in this area to demonstrate the benefit of loco‐regional treatment using TACE and RT compared with sorafenib alone and assessed progression‐free survival (PFS) (12‐week PFS: 86.7% vs. 34.4%, P < 0.001) and OS (median OS 55.0 vs. 43.0 weeks, P = 0.04).…”

Section: Major Trials and Meta‐analysesmentioning

confidence: 99%

“…Rim et al recently published a meta‐analysis comparing radiotherapeutic modalities for HCC with portal vein thrombosis (PVT). PVT are cases in which RT is commonly applied because local RT might increase the efficiency of TACE and reduce complications such as varices and bleeding owing to portal hypertension .…”

Section: Major Trials and Meta‐analysesmentioning

confidence: 99%

“…16,28 Local treatment using EBRT has been commonly performed, especially for patients with portal invasion. 29 Yoon et al 27 designed and performed the first meaningful RCT in this area to demonstrate the benefit of loco-regional treatment using TACE and RT compared with sorafenib alone and assessed progression-free survival (PFS) (12-week PFS: 86.7% vs. 34.4%, P < 0.001) and OS (median OS 55.0 vs. 43.0 weeks, P = 0.04). It is noteworthy that the study resulted in the benefit of locoregional treatment (LRT), even when treatment crossover after disease progression was permitted.…”

Section: Major Trials and Meta-analysesmentioning

confidence: 99%

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Recent clinical applications of external beam radiotherapy for hepatocellular carcinoma according to guidelines, major trials and meta‐analyses

Rim

Yim²,

Park

et al. 2019

J Med Imag Rad Onc

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Summary External beam radiotherapy (EBRT) for hepatocellular carcinoma (HCC) has not been widely used due to lack of high‐level evidence, despite its potent local therapeutic effect. While clinical evidence has accumulated and meta‐analyses of observational studies have provided integrated information to help in clinical decision‐making, a recent randomized trial demonstrated the benefit of EBRT in cases of HCC with major vessel invasion. Based on these trends, the efficacy of EBRT has been better recognized, and EBRT has been more frequently recommended in several international treatment guidelines newly updated in 2018. This review examined the key issues of EBRT in the guidelines updated in 2018 as well as recently published noteworthy randomized trials and meta‐analyses. Ongoing trials to identify the trends and direction of future research on EBRT for HCC were also reviewed.

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Comparison of three‐dimensional conformal radiotherapy and hepatic resection in hepatocellular carcinoma with portal vein tumor thrombus

Chen

Liang

et al. 2018

Cancer Medicine

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ObjectiveThis study aimed to evaluate the safety and efficacy of three‐dimensional conformal radiotherapy (3D‐CRT) and hepatic resection for patients with hepatocellular carcinoma (HCC) involving portal vein tumor thrombus (PVTT).MethodsWe retrospectively analyzed 323 HCC patients involving PVTT. Among them, 134 patients underwent 3D‐CRT, while 189 controls treated with hepatic resection (HR). Survival rate and prognostic analysis were performed using Kaplan‐Meier method and Cox regression analyses.ResultsThe 1‐, 2‐, and 3‐year overall survival (OS) of RT group and HR group was 54% vs 62%, 33% vs 47%, and 18% vs 43%, respectively (P = 0.003). In the subgroup of PVTT type analysis, the 1‐, 2‐, and 3‐year OS in RT group was 65%, 39%, and 19%, respectively, while that in HR group was 83%, 53%, and 42%, respectively, in type I PVTT (P < 0.001). The 1‐, 2‐, and 3‐year OS in RT group was 52%, 35%, and 11%, while that in HR group was 55%, 42%, and 25%, respectively, in type II PVTT (P = 0.612). In type III PVTT, the 1‐, 2‐, and 3‐year OS in RT group was 16%, 3%, and 0%, respectively, while that in HR group was 11%, 0%, and 0%, respectively (P = 0.041). Multivariate analysis revealed that tumor size ≥10 cm, Child‐Pugh class B, and type III PVTT are independent predictors of poor prognosis in HCC with PVTT.Conclusion3D‐CRT appears to be an effective treatment for patients with HCC involving type II/III PVTT.

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Comparison of radiation therapy modalities for hepatocellular carcinoma with portal vein thrombosis: A meta-analysis and systematic review

Cited by 88 publications

References 84 publications

Radiation Therapy in HCC: What Data Exist and What Data Do We Need to Incorporate into Guidelines?

Radiation Therapy in HCC: What Data Exist and What Data Do We Need to Incorporate into Guidelines?

Recent clinical applications of external beam radiotherapy for hepatocellular carcinoma according to guidelines, major trials and meta‐analyses

Comparison of three‐dimensional conformal radiotherapy and hepatic resection in hepatocellular carcinoma with portal vein tumor thrombus

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