A Meta-analysis of transcatheter arterial chemoembolization comparing stereotactic body radiation the-rapy in patients for primary hepatic carcinoma

Abstract

Objective To compare the clinical efficacy and the adverse reaction of transcatheter arterial chemoembolization (TACE) alone and combined with stereotactic body radiation therapy (SBRT) in patients with primary hepatic carcinoma by a Meta-analysis. Methods PubMed, Cochrane Library, EMBase, Ovid, MEDLIN, CNKI, CBMdisc, VIP and Wanfang were searched to identify the controlled clinical trials of TACE and SBRT for primary hepatic carcinoma. The obtained data were analyzed using Review Manager version 5.2 provided by Cochrane Collaboration. To analysis the short-term effect of TACE alone or combined with SBRT, the rate of local tumor control and the difference of one, two, three and five-year survival rate. Results A total of 1 143 patients from 10 controlled clinical trials were involved according to the inclusion criteria. The Meta-analysis showed that TACE and SBRT group significantly increased the short-term effective rate, the rate of local tumor control, l-, 2-, 3-and 5-year overall survival rates(RR=1.43, 95%CI: 1.32-1.56, P<0.000 01; RR=2.09, 95%CI: 1.63-2.69, P<0.000 01; RR=1.31, 95%CI: 1.21-1.42, P<0.000 01; RR=1.46, 95%CI: 1.23-1.72, P<0.000 01; RR=1.76, 95%CI: 1.14-2.71, P=0.01; RR=2.29, 95%CI: 1.22-4.32, P=0.01). There was no statistically significant difference between the two groups on adverse events such as leucopenia(RR=0.97, P=0.61), thrombocytopenia(RR=0.99, P=0.85), hemoglobin decrease(RR=0.95, P=0.63), nausea and vomiting(RR=1.00, P=0.98), liver function damage(RR=0.98, P=0.87). Conclusion Compared with TACE, TACE combined with SBRT can increase the short-term effective rate, the rate of local tumor control, the 1-, 2-, 3-and 5-year overall survival time of the patients, and does not increase the incidence of adverse reaction. However high-quality trials with large sample sizes are still needed to verify the long-term efficacy and safety. Key words: Liver neoplasms; Meta-analysis; Transcatheter arterial chemoembolization; Stereotactic body radiation therapy