Radiotherapy Beneficial for TACE-Treated Inoperable Liver Cancer Patients

Unresectable hepatocellular carcinoma survival is improved by addition of radiotherapy to transcatheter arterial chemoembolisation

medwireNews: Radiotherapy (RT) boosts survival for patients with unresectable hepatocellular carcinoma (HCC) undergoing transcatheter arterial chemoembolisation (TACE), confirm the results of a systematic review and meta-analysis.

Charles Thomas Jr writes in an editor’s note to the JAMA Oncology study that the findings “provide some rationale for dual-modality liver-directed therapy being conducted at many centers.”

Nevertheless, he emphasises that “the ill-defined therapeutic landscape for localized HCC requires the completion and reporting of well-designed prospective trials that incorporate a multidisciplinary approach and include investigators working together.”

Pooled data for 2577 participants of 11 randomised controlled trials and 14 other types of studies gave an odds ratio (OR) for 1-year survival of 1.36 for TACE plus RT versus TACE alone, increasing to ORs of 1.55, 1.91, 3.01 and 3.98 in years 2, 3, 4 and 5, respectively.

Patients given TACE alongside moving strip whole-liver RT, 3-dimensional conformal RT or stereotactic RT were also significantly more likely to achieve a complete response than those given TACE only, with an OR of 2.73.

The addition of RT to TACE was associated with an increased risk of gastroduodenal ulcers and an increase in levels of alanine transaminase and total bilirubin. But there was no significant difference between TACE with and without RT with regard to side effects such as nausea, leukopenia or oesophagitis.

“TACE plus RT was more therapeutically beneficial than TACE alone for treating HCC, and should be recommended for suitable patients with unresectable HCC”, advise Ya Ruth Huo and Guy Eslick, from the University of Sydney in New South Wales, Australia.

However, the authors observe that the meta-analysis was limited by poor quality trial design and explain that as all the studies meeting the criteria were conducted in the East, the findings “may not be applicable” to Western patients because of differences in HCC aetiology.

Charles Thomas Jr adds that the meta-analyses results would also have been “strengthened” by use of the Liver Imaging Reporting and Data System guidelines for imaging.

He comments: “This study does not tell us whether radiofrequency ablation, often used as a consolidative liver-directed approach, is equal to consolidative radiotherapy, nor does it define the impact of other predictive and prognostic factors, such as the initial [Barcelona Clinic Liver Cancer] stage, variability in target delineation, treatment planning, use and type of image-guidance techniques, radiotherapy dose-fractionation, and differences between Asian and non-Asian patients.”

References

Huo YR, Eslick GD. Transcatheter arterial chemoembolization plus radiotherapy compared with chemoembolization alone for hepatocellular carcinoma. A systematic review and meta-analysis. JAMA Oncol 2015; Advance online publication 9 July. doi:10.1001/jamaoncol.2015.2189

Thomas Jr CR. Dual-modality liver-directed therapy for primary liver cancer. JAMA Oncol 2015; Advance online publication 9 July. doi:10.1001/jamaoncol.2015.2197

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