Meta-Analysis
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World J Gastroenterol. Dec 7, 2014; 20(45): 17227-17234
Published online Dec 7, 2014. doi: 10.3748/wjg.v20.i45.17227
3D conformal radiotherapy combined with transcatheter arterial chemoembolization for hepatocellular carcinoma
Li-Qun Zou, Bing-Lan Zhang, Qing Chang, Fu-Ping Zhu, Yan-Yan Li, Yu-Quan Wei, Yong-Song Guan
Li-Qun Zou, Bing-Lan Zhang, Yan-Yan Li, Yu-Quan Wei, Yong-Song Guan, Department of Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Qing Chang, Fu-Ping Zhu, Department of Hepatobiliary Surgery, The Ninth People’s Hospital of Chongqing, Chongqing 400700, China
Author contributions: Zou LQ, Zhang BL and Chang Q contributed equally to this work; Zou LQ, Zhang BL, Chang Q, Zhu FP, Li YY, Wei YQ and Guan YS designed research; Zou LQ, Zhang BL, Chang Q, Zhu FP and Li YY performed research; Zou LQ, Zhang BL, Chang Q, Wei YQ and Guan YS analyzed data; and Zou LQ, Zhang BL and Chang Q wrote the paper.
Correspondence to: Yong-Song Guan, MD, Department of Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 37 Guoxuexiang Street, Chengdu 610041, Sichuan Province, China. yongsongguan@yahoo.com
Telephone: +86-28-85422683 Fax: +86-28-85423046
Received: February 11, 2014
Revised: June 5, 2014
Accepted: July 22, 2014
Published online: December 7, 2014
Abstract

AIM: To compare transcatheter arterial chemoembolization (TACE) and 3D conformal radiotherapy (3D-CRT) with TACE monotherapy in hepatocellular carcinoma (HCC).

METHODS: We searched all the eligible studies from the Cochrane Library, PubMed, Medline, Embase, and CNKI. The meta-analysis was performed to assess the survival benefit, tumor response, and the decline in α-fetoprotein (AFP) level. According to the heterogeneity of the studies, pooled OR with 95%CI were calculated using the fixed-effects or random-effects model. An observed OR > 1 indicated that the addition of 3D-CRT to TACE offered survival benefits to patients that could be considered statistically significant. Statistical analyses were performed using Review Manager Software.

RESULTS: Ten studies met the criteria to perform a meta-analysis including 908 HCC participants, with 400 patients in the TACE/3D-CRT combination group and 508 in the TACE alone group. TACE combined with 3D-CRT significantly improved 1-, 2- and 3-year overall survival compared with TACE monotherapy (OR = 1.87, 95%CI: 1.37-2.55, P < 0.0001), (OR = 2.38, 95%CI: 1.78-3.17, P < 0.00001) and (OR = 2.97, 95%CI: 2.10-4.21, P < 0.00001). In addition, TACE plus 3D-CRT was associated with a higher tumor response (complete remission and partial remission) (OR = 3.81; 95%CI: 2.70-5.37; P < 0.00001), and decline rates of AFP level (OR = 3.24, 95%CI: 2.09-5.02, P < 0.00001).

CONCLUSION: This meta-analysis demonstrated that TACE combined with 3D-CRT was better than TACE monotherapy for patients with HCC, which needs to be confirmed by large multicenter trials．

Keywords: Hepatocellular carcinoma, Chemoembolization, Three-dimensional conformal radiotherapy, Meta-analysis

Core tip: Transcatheter arterial chemoembolization (TACE) is the most commonly used palliative therapy for patients with unresectable hepatocellular carcinoma (HCC), which can prolong survival with unsatisfactory long-term effects. 3D conformal radiotherapy (3D-CRT) has been utilized for HCC in a series of trials, with promising results. This meta-analysis demonstrated that TACE combined with 3D-CRT was better than TACE monotherapy for the treatment of HCC, which still needs to be confirmed by large prospectively randomized, controlled, multicenter trials.