The Efficacy Of Radiation Therapy Versus Transcatheter Arterial Chemoembolization For The Treatment Of Primary Hepatocellular Carcinoma:A Meta-analysis

Objective The meta-analysis was designed to investigate the efficacy of radiotherapy alone versus TACE in the treatment of the primary hepatocellular carcinoma patients by comparing the total effective rate and the survival rate,so as to provide reference for clinical practice.Methods The combination of computer and manual retrieval was conducted to search the controlled clinical trials of radiotherapy for primary hepatocellular carcinoma published publicly at home and abroad from January 2000 to January 2018.A comprehensive search was conducted in Pub Med,Embase,Cochrane Library,Web of Science,Sino Med,VIP,CNKI and Wanfang.Eligible studies were identified by two trained professionals,and extracted necessary data.The primary outcomes were total effective rate,6-month survival rate,1-year survival rate,2-year survival rate,and 3-year survival rate.The secondary outcome was incidence of adverse reactions.Statistical analysis was performed using the Review Manager 5.3 software.Results Through the above methods,12 studies were finally included.The 12 studies included were all from China.All the studies were published from 2009 to 2016,including 11 Chinese and 1 English;2 randomized controlled trials and 10 retrospective cohort study.The sample sizes of the included literatures ranged from 18 to 190,including 1,089 patients,with 565 patients in the radiotherapy alone group(RT group)and 524 patients in the TACE alone group(TACE group).Radiotherapy techniques include Stereotactic body radiation therapy(SBRT),three-dimensional Conformal radiotherapy(3D-CRT),Intensity modulated radiation therapy(IMRT)and other precise external radiotherapy techniques.Themeta-analysis of the included studies showed that the statistical results of total effective rate(CR + PR percentage,OR=1.45,95%CI:0.98~2.13,P>0.05),6 months survival rate(OR=1.43,95%CI:0.66~3.09,P>0.05),1 year survival rate(OR=1.39,95% CI:0.98 ~ 1.96,P > 0.05),and 2 year survival rate(OR=1.04,95% CI:0.66 ~ 1.62,P > 0.05)showed no significant difference between RT group and TACE group,and the statistical results of the 3 years survival rate(OR=1.57,95% CI:1.01 ~ 2.42,P < 0.05)showed that the RT group was higher to the TACE group.Conclusion For patients with primary hepatocellular carcinoma who are unsuitable or unwilling to surgery,the short-term efficacy of radiotherapy alone is similar to that of TACE,and its long-term efficacy is superior to TACE.Radiotherapy can be used as an important means for comprehensive treatment of primary hepatocellular carcinoma.High quality evidence-based medicine evidence is still required to confirm these findings.