Transcatheter arterial chemoembolization in combination with radiotherapy for unresectable hepatocellular carcinoma: a systematic review and meta-analysis.
OBJECTIVE
To evaluate the efficacy and safety of transcatheter arterial chemoembolization (TACE) plus radiotherapy (RT) for unresectable hepatocellular carcinoma (UHCC) using meta-analysis of data from the literature involving available randomized controlled trials of TACE in combination with RT compared with that of TACE alone (Therapy I versus II) in treating UHCC.


METHODS
We searched the Cochrane Library, MEDLINE, CENTRAL, EMBASE, CBMdisc, and CNKI as well as employing manual searches. Meta-analysis was performed on the results of homogeneous studies. Analyses subdivided by study design were also performed.


RESULTS
We found 17 trials involving 1476 patients. 5 of total were Randomized Controlled Trials (RCTs) and 12 were Non-randomized Controlled Clinical Trials (CCTs). In terms of quality, 5 RCTs were graded B, and 12 CCTs were graded C. Our results showed that Therapy I, compared with Therapy II, significantly improved the survival and the tumor response of patients, and was thus more therapeutically beneficial. Serious adverse events were not increased exception for total bilirubin (TB) level.


CONCLUSIONS
Therapy I was more therapeutically beneficial. However, considering the strength of the evidence, additional randomized controlled trials are needed before Therapy I can be recommended routinely.
Meng
Mao-Bin
MB
Division of Thoracic Cancer, West China Hospital, West China School of Medicine, Sichuan University, #37 Guoxue Lane, Chengdu, China.
Cui
Yao-Li
YL
Lu
You
Y
She
Bin
B
Chen
Yan
Y
Guan
Yong-Song
YS
Zhang
Rui-Ming
RM
D000410:Alanine Transaminase / Q000097:blood; D001663:Bilirubin / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects; D003131:Combined Modality Therapy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000628:therapy*; D017594:Publication Bias
D000410:Alanine Transaminase; D001663:Bilirubin