医学
肝细胞癌
内科学
科克伦图书馆
危险系数
肝切除术
外照射放疗
佐剂
肿瘤科
荟萃分析
系统回顾
随机对照试验
回顾性队列研究
不利影响
外科
放射治疗
胃肠病学
梅德林
近距离放射治疗
置信区间
切除术
法学
政治学
作者
Lei Wang,Qin Lü,Qiao Ke,Hongbing Ji,Junxin Wang
标识
DOI:10.1016/j.radonc.2022.08.019
摘要
Recurrence remains the main bottleneck hindering outcomes of hepatectomy for hepatocellular carcinoma (HCC). Owing to technological advances, external beam radiotherapy (EBRT) is being increasingly used in the management of HCC; however, there is no consensus on the role of adjuvant EBRT following hepatectomy.A systematic review was conducted according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. PubMed, MedLine, Embase, the Cochrane Library, Web of Knowledge were used to screen eligible studies (published as of May 1st, 2022) that evaluated the clinical safety and efficacy of EBRT for HCC receiving hepatectomy. The endpoints were disease-free survival (DFS), overall survival (OS), and adverse events (AEs).A total of ten studies were eligible (three randomized controlled trials, one phase II trial, and six retrospective comparative studies). The pooled hazard ratio (HR) for median DFS and OS were both in favor of adjuvant EBRT compared with surgery alone (all P < 0.05), and the advantage of adjuvant EBRT was also confirmed in subgroups stratified by different populations (narrow margin, P < 0.05; microvascular invasion, P < 0.05; portal vein tumor thrombus, P < 0.05) and study designs (prospective studies, P < 0.05; retrospective studies, P < 0.05). Adjuvant EBRT was also found to be superior to adjuvant TACE (P < 0.05). Pooled rates of overall AEs and severe AEs were 65.3% and 12.2%, but no fatal AEs were reported.Adjuvant EBRT can be considered for HCC patients, especially those with a high risk of recurrence. Further studies are required for validation of these findings.
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