Meta-analysis of randomized controlled trials of external-beam radiation versus transarterial chemoembolization for hepatocellular carcinoma

Abstract

Background

External-beam radiation (EBRT) is a noninvasive therapeutic alternative to transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). The objective of this study was to conduct a systematic review and meta-analysis of prospective randomized clinical trials to assess the clinical efficacy of EBRT versus TACE for HCC as either a definitive monotherapy or as a bridge to transplantation/surgery.

Methods

A systematic review and meta-analysis were performed to include prospective randomized trials comparing EBRT versus TACE. Data was analyzed with random and fixed-effects models. The inconsistency index (I²) was chosen to assess heterogeneity. Three publications were included with a total of 142 patients. Outcomes included local control (LC), overall survival (OS), progression-free survival (PFS), and occurrences of grade ≥3 toxicity. Comparisons are reported as hazard ratios (HRs) or risk ratios (RRs) with 95% confidence intervals (CIs).

Results

There were three randomized trials that met inclusion criteria. The EBRT was delivered in three to 15 fractions with a total dose between 30 and 75 gray(Gy). EBRT was associated with significantly improved LC (HR, 0.16; 95% CI, 0.08–0.34; I² = 0%) and PFS (HR, 0.37; 95% CI, 0.23–0.60; I², 0%) compared with TACE. There was no significant difference between EBRT and TACE in OS (RR, 0.79; 95% CI, 0.51–1.22; I² = 0%) or grade ≥3 toxicity (RR, 0.86; 95% CI, 0.31–2.37; I² = 57%). None of the analyses had statistically significant heterogeneity.

Conclusions

Compared with TACE, EBRT yields superior LC and PFS without providing a survival benefit in early and intermediate stage HCC. Additional larger prospective randomized controlled trials should be conducted to further investigate differences in clinical outcomes amongst patients with more advanced disease.