Efficacy and Safety of Transarterial Chemoembolization Plus External Beam Radiotherapy vs Sorafenib in Hepatocellular Carcinoma With Macroscopic Vascular Invasion

Abstract

clinicaltrials.gov Identifier: NCT01901692.

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

“…The study encompassed 25 trials, including 11 RCTs; however, 10 of the 11 RCTs did not provide details regarding the random allocation sequence. Nevertheless, this study provided the best supporting evidence for the use of combined TACE and RT, until the RCT by Yoon et al was published.…”

“…When combined with radiotherapy, TACE increases radiosensitivity, while tumour‐targeting guidance with lipiodol enables more accurate RT . The combination of TACE and RT was beneficial compared with TACE alone for unresectable HCCs in a previous meta‐analysis; moreover, for major vessel invasion cases, combined TACE and RT had better OS and PFS than sorafenib in a recent RCT …”

“…Research partnerships between vendor–health providers have been poorly settled in RT for liver cancers, and conducting prospective randomized trials to provide high‐level evidence has been difficult. Nevertheless, a recent randomized controlled trial (RCT) compared sorafenib and combined TACE and EBRT for HCCs with major vascular invasion …”

“…Four trials (4 of 24, 16.7%) compared local ablation such as RFA or microwave ablation vs. EBRT. Among two trials comparing sorafenib vs. LRT, including EBRT, a study comparing sorafenib vs. TACE and EBRT has been published, while the trial by the Radiation Therapy Oncology Group comparing sorafenib vs. sorafenib and SBRT is ongoing. Among single‐arm trials, the majority (six of nine, 66.7%) are analysing the effect of sorafenib or other novel systemic agents combined with EBRT; the remaining three trials are assessing the combination of EBRT and other local modalities.…”

“…Although EBRT for HCC is commonly practiced in the clinic, robust scientific evidence through prospective controlled trials has been scarce owing to limitations, such as its use being limited to cases not amenable to TACE or RFA, lack of vendor–practitioner co‐working research systems and less research interest compared with that for more common cancers in developed countries, such as breast or prostate cancers. Nevertheless, the efforts of many researchers have accumulated a great deal of clinical experience, and meta‐analyses of observational studies have integrated information to help clinical decision‐making, while a recent randomized trial demonstrated the survival benefit of EBRT for HCC with major vessel invasion compared to sorafenib alone . Recently, the efficacy of EBRT has been introduced in several international clinical guidelines, and ongoing studies are expected to provide high‐grade evidence in the near future.…”