title: Comparison of intra-arterial chemoembolization with and without radiotherapy for advanced hepatocellular carcinoma with portal vein tumor thrombosis: a meta-analysis.
abstract: OBJECTIVE
  Numerous studies have tried to combine transarterial chemoembolization (TACE) or hepatic arterial infusion chemotherapy (HAIC) with radiotherapy (RT) for the treatment of hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT). However, the efficacy of TACE or HAIC combined with RT versus TACE or HAIC alone remains controversial. Thus, we performed a meta-analysis to compare the efficacy and safety of intra-arterial chemoembolization combined with RT versus intra-arterial chemoembolization alone for the treatment of HCC patients with PVTT.
  
  
  METHODS
  PubMed, Embase, and Cochrane Library databases were systematically searched for eligible studies. Two authors independently reviewed the abstracts, extracted relevant data and rated the quality of studies. The major end points were objective response rate (ORR), overall survival (OS), and adverse events.
  
  
  RESULTS
  Eight studies with a total of 1,760 patients were included in this meta-analysis. The pooled results showed that intra-arterial chemoembolization combined with RT significantly improved ORR of PVTT (OR, 4.22; 95% CI, 3.07-5.80;P<0.001) and OS (HR, 0.69; 95% CI, 0.57-0.83;P=0.001), but did not affect ORR of primary liver tumor (OR, 1.37; 95% CI, 0.67-2.79;P=0.390). The incidence of grade 3 or 4 leukopenia (OR, 5.80; 95% CI, 2.478-13.56;P<0.001) and thrombocytopenia (OR, 3.77; 95% CI, 1.06-13.43;P=0.041) was higher in the intra-arterial chemoembolization plus RT group than in the intra-arterial chemoembolization group.
  
  
  CONCLUSIONS
  Combination therapy of intra-arterial chemoembolization and RT for HCC patients with PVTT could bring higher ORR of PVTT and better survival benefits. This combination therapy was also associated with a significantly increased risk of adverse events. However, they were mostly mild to moderate and successfully treated with conservative treatment.
authors.affiliation: School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences; Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Jinan, People's Republic of China.
authors.forename: Qianqian
authors.initials: Q
authors.lastname: Zhao
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Jinan, People's Republic of China.
authors.forename: Kunli
authors.initials: K
authors.lastname: Zhu
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Jinan, People's Republic of China.
authors.forename: Jinbo
authors.initials: J
authors.lastname: Yue
authors.affiliation: School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences; Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Jinan, People's Republic of China.
authors.forename: Zhonghua
authors.initials: Z
authors.lastname: Qi
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Jinan, People's Republic of China.
authors.forename: Shumei
authors.initials: S
authors.lastname: Jiang
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Jinan, People's Republic of China.
authors.forename: Xiaoqing
authors.initials: X
authors.lastname: Xu
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Jinan, People's Republic of China.
authors.forename: Rui
authors.initials: R
authors.lastname: Feng
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Jinan, People's Republic of China.
authors.forename: Renben
authors.initials: R
authors.lastname: Wang
keywords: hepatocellular carcinoma; intra-arterial chemoembolization; meta-analysis; portal vein tumor thrombus; radiotherapy