Stereotactic body radiotherapy plus transcatheter arterial chemoembolization for inoperable hepatocellular carcinoma patients with portal vein tumour thrombus: A meta-analysis.

BACKGROUND: The efficacy and safety of stereotactic body radiotherapy (SBRT) plus transcatheter arterial chemoembolization (TACE) versus SBRT or TACE alone(monotherapy) for hepatocellular carcinoma (HCC) patients with portal vein tumour thrombus (PVTT) remains controversial. This meta-analysis was performed to provide more powerful evidence for clinical strategies in inoperable HCC with PVTT. METHODS: We searched the PubMed, EMBASE, Web of Science, Cochrane Library, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), VIP Journal Integration Platform (VIP), and WanFang databases for eligible studies. We pooled the results of 1- and 2-year overall survival rates (OSRs), objective response rates (ORRs), and adverse events (AEs) between the two groups and performed a subgroup meta-analysis for study type, control group, treatment order, and the interval between SBRT and TACE. RESULTS: Nine studies with 10 cohorts involving 938 patients were included in our meta-analysis. SBRT plus TACE yielded significantly higher 1-year OSR (RR, 1.52[95% CI, 1.33-1.74]), 2-year OSR (RR, 2.00 [95% CI: 1.48-2.70]), ORR (RR = 1.22 [95% CI, 1.08-1.37]), and a lower progression disease (PD) rate (RR = 0.45 [95% CI:0.26-0.79]) than monotherapy. No significant differences were detected in CR, PR, SD, or AEs between the two groups. Subgroup analysis regarding study type, control group, and treatment order indicated that compared with monotherapy, the combination of SBRT with TACE was associated with an increase in 1- and 2-year OSRs but not in ORR. In regard to the interval between SBRT and TACE, subgroup analysis found that the combination therapy for patients with an SBRT-TACE interval <28 days was preferable to monotherapy in the 1- and 2-year OSRs, and ORR. However, for patients with an SBRT-TACE interval ≥28 days, no obvious distinctions were observed in the 1-year OSR, 2-year OSR, or ORR between the two groups. CONCLUSION: The combination of SBRT with TACE appears to be better than monotherapy in treating HCC with PVTT and should be recommended for inoperable HCC patients with PVTT.

Long-term survival analysis in combined transarterial embolization and stereotactic body radiation therapy versus stereotactic body radiation monotherapy for unresectable hepatocellular carcinoma >5 cm.

BACKGROUND: The survival following transarterial chemoembolization (TACE) alone is still low in unresectable hepatocellular carcinoma (HCC) with almost patients developing disease progression after treatment. There is need to investigate additional therapeutic options that would intensify the initial response to TACE. The present study was to retrospectively compare the outcome and evaluate the prognostic factors of stereotactic body radiation therapy (SBRT) alone or as an adjunct to transarterial embolization (TAE) or TACE in the treatment of HCC >5 cm. METHODS: From January 2011 to April 2015, 77 patients received SBRT followed by TAE or TACE (TAE/TACE + SBRT group) and 50 patients received SBRT alone (SBRT group). The dose of SBRT was 30-50 Gy which was prescribed in 3-5 fractions. Eligibility criteria were: a longest tumor diameter >5.0 cm and Child-Turcotte-Pugh (CTP) Class A or B. Exclusion criteria included tumor thrombus, lymph node involvement and extrahepatic metastasis. RESULTS: The median follow-up period was 20.5 months. Median tumor size was 8.5 cm (range, 5.1-21.0 cm). Median overall survival (OS) in the TAE/TACE + SBRT group was 42.0 months versus 21.0 months in the SBRT group. The 1-, 3- and 5-year OS was 75.5, 50.8, and 46.9 % in the TAE/TACE + SBRT group and was 62.4, 32.9, and 32.9 % in the SBRT group, respectively (P = 0.047). The 1-, 3- and 5-year distant metastasis-free survival (DMFS) was 66.3, 44.3, and 40.6 % in the TAE/TACE + SBRT group and was 56.8, 26.1, and 17.4 % in the SBRT group, respectively (P = 0.049). The progression-free survival (PFS) and local relapse-free survival (LRFS) were not significantly different between the two groups. In the entire patient population, a biologically effective dose (BED10) ≥100 Gy and an equivalent dose in 2 Gy fractions (EQD2) ≥74 Gy were significant prognostic factors for OS, PFS, LRFS and DMFS. CONCLUSIONS: SBRT combined with TAE/TACE may be an effective complementary treatment approach for HCC >5 cm in diameter. BED10 ≥100 Gy and EQD2 ≥74 Gy should receive more attention when the SBRT plan is designed.

[Primary hepatocarcinoma treated by traditional Chinese medicine combined with transcatheter arterial chemoembolization].

OBJECTIVE: To observe the effect of traditional Chinese medicine (TCM) combining transcatheter arterial chemoembolization (TACE) in patients with primary hepatocarcinoma (PHC), and its influence on patients' immunity, quality of life and adverse reaction. METHODS: Sixty-seven patients with mid-advanced stage PHC were assignd to two groups: the 35 patients in Group 1 treated with TCM combined TACE and the 32 in Group 2 treated with TACE alone. TACE with Gemzar (GEM) and Cisplatinum (DDP) were applied once in both groups, and followed by conventional post-operational management as hydration. The TCM used was prescribed according to syndrome differentiation. Peripheral blood T-lymphocyte subsets and natural killer (NK) cells of patients were measured before treatment (as the base line) and at the end of the 1st and 4th week after treatment (W1, W4), patients' quality of life (QOL) was estimated at the sametime by Karnofsky sore (KPS). Moreover, CT or MRI examination was performed at end of the 4th week to evaluate the short-term efficacy of treatment. RESULTS: Short-term efficacy analyses showed that the effective rate was 51.4% (18/35) in Group 1 and 37.5% (12/32) in Group 2, showing insignificant difference between them (P > 0.05). The levels of CD3+, CD4+, CD4+/CD8+, NK cells actionties and KPS score reduced slightly in both groups at W1, with no significant intergroup difference; but at W4, they did show significant differences between groups, and all indices in both groups were significantly different to those of the baseline and at W1 (P < 0.05 or P < 0.01). Aduerse reaction occurred were mainly fever, digestive reaction and lowering of peripheral white blood cell counting, platelet counting, etc. and the incidence of fever in Group 1 was lower than in Group 2. CONCLUSION: TCM treatment combined with TACE can enhance the immunity and QOL of PHC patients, and alleviate the adverse reaction of chemotherapeutic agents.