Unraveling the efficacy network: A network meta-analysis of adjuvant external beam radiation therapy methods after hepatectomy

ARTICLE HIGHLIGHTS

Research background

Patients with primary liver cancer face a high recurrence rate, impacting prognosis significantly. Research has demonstrated the effectiveness of postoperative adjuvant external radiation therapy (RT) in preventing liver cancer recurrence after resection. However, the varying effects of different RT techniques on postoperative liver cancer recurrence necessitate further exploration and investigation.

Research motivation

This study aims to uncover and compare the efficacy of different adjuvant external beam RT (EBRT) methods after hepatectomy. Ultimately, the goal is to guide future experimental investigations, clinical practices, and potentially identify new directions for liver cancer treatment.

Research objectives

This study conducted a network meta-analysis to evaluate different adjuvant external RT methods following liver resection, focusing on overall survival (OS) and disease-free survival (DFS) to identify the optimal approach.

Research methods

In adherence to PRISMA guidelines, this study utilized network meta-analyses to collect data from qualified studies published before July 10, 2023, from various reputable databases. Specifically, relevant studies pertaining to postoperative EBRT following liver resection with OS and DFS as primary endpoints were included for analysis. The effects were evaluated using risk ratios and 95% confidential intervals, with data analysis performed via R and STATA software for comprehensive assessment.

Research results

Inclusive of 1265 patients with hepatocellular carcinoma (HCC) post-liver resection, 12 studies formed the basis of this study. The absence of significant heterogeneity in direct paired comparisons, and consistency in inclusion/exclusion criteria, intervention measures, and outcome indicators, corroborated the assumptions of heterogeneity and transitivity. Findings from the analysis of OS indicated that patients who received stereotactic body radiotherapy (SBRT) after resection exhibited longer OS compared to those who underwent intensity modulated radiotherapy (IMRT) or 3-dimensional conformal RT (3D-CRT). Moreover, the analysis of DFS revealed that patients treated with 3D-CRT after resection had the longest DFS, while those undergoing IMRT post-resection demonstrated longer OS compared to 3D-CRT and longer DFS compared to SBRT.

Research conclusions

When considering RT options after liver cancer resection for HCC patients, IMRT stands out as a preferred choice due to its association with longer OS than 3D-CRT and longer DFS than SBRT.

Research perspectives

The role of RT in liver cancer treatment is currently uncertain, with some practitioners deeming its use rare and insufficiently effective alongside surgical resection. However, basic research shows that RT can influence epigenetic regulation, apoptosis programming, and the tumor immune microenvironment, potentially extending disease-free and OS. Further understanding of RT mechanisms can pave the way for combining it with chemotherapy, targeted therapy, and immunotherapy, offering new directions for clinical practices.