Is the Concurrent Use of Sorafenib and External Radiotherapy Feasible for Advanced Hepatocellular Carcinoma? A Meta-Analysis.
Is the Concurrent Use of Sorafenib and External Radiotherapy Feasible for Advanced Hepatocellular Carcinoma? A Meta-Analysis.
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DOI：
10.3390/cancers13122912
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发表时间：
2021-06-10
期刊：
影响因子：
5.2
通讯作者：
Yoon WS
中科院分区：
文献类型：
--
作者：
Rim CH;Park S;Shin IS;Yoon WS
同步化疗和外照射是癌症治疗的常用方法。然而，索拉非尼和外放射治疗的同时应用在临床实践中并不常用，因为可能存在过度并发症的风险。这项荟萃分析的结果表明，同时治疗可能是一种可行的选择，特别推荐针对转移性病变或血管受累的治疗。我们评估索拉非尼和外照射放射治疗（EBRT）同时应用于晚期肝细胞癌（HCC）的可行性。检索了截至2021年4月9日的PubMed、Embase、Medline和科克伦图书馆。主要终点为≥3级并发症，次要终点为总生存期（OS）。对EBRT靶点研究进行亚组分析，肝内与非肝内病变（例如，仅肝外转移或恶性血管受累）。本荟萃分析纳入了11项研究，涉及512例患者。胃肠道、肝脏、血液学和皮肤学≥3级毒性的合并发生率为8.1%（95%置信区间（CI）：4.8-13.5，I2 = ~0%），12.9%（95% CI：7.1-22.1，I2 = 22.4%）、9.1%（95% CI：3.8-20.3，I2 = 51.3%）和6.8%（95% CI：3.8-11.7，I2 = ~0%）。针对非肝内病变的研究中汇总的≥3级肝脏和血液学毒性发生率低于针对肝内病变的研究（肝脏：3.3% vs. 17.1%，p = 0.041;血液学：3.3% vs. 16.0%，p = 0.078）。胃肠道和皮肤科≥3级并发症在亚组之间无显著差异。关于OS，合并治疗比非合并治疗更有益（比值比：3.3，95% CI：1.3-8.59，p = 0.015）。一项研究报告了一例由于肿瘤破裂和胃肠道出血而导致的致命毒性。可以考虑合并治疗，并应用于靶向转移性病变或局部血管受累。肝内病变应根据靶区大小和肝脏储备情况谨慎治疗。
Concurrent chemotherapy and external radiation is a commonly used method for cancer treatment. However, concurrent application of sorafenib and external radiotherapy has not been commonly used in clinical practice due to the possible risk of excessive complication. The results of this meta-analysis suggest that concurrent treatment might be a feasible option, and treatment targeting metastatic lesion or vessel involvement is particularly recommended. We evaluate the feasibility of a concurrent application of sorafenib and external beam radiation therapy (EBRT) for advanced hepatocellular carcinoma (HCC). PubMed, Embase, Medline, and Cochrane Library were searched up to 9 April 2021. The primary endpoint was grade ≥3 complications, and the secondary endpoint was overall survival (OS). Subgroup analyses were performed for studies with the EBRT targets, intrahepatic vs. non-intrahepatic lesions (e.g., extrahepatic metastases or malignant vessel involvement only). Eleven studies involving 512 patients were included in this meta-analysis. Pooled rates of gastrointestinal, hepatologic, hematologic, and dermatologic grade ≥3 toxicities were 8.1% (95% confidence interval (CI): 4.8–13.5, I2 = ~0%), 12.9% (95% CI: 7.1–22.1, I2 = 22.4%), 9.1% (95% CI: 3.8–20.3, I2 = 51.3%), and 6.8% (95% CI: 3.8–11.7, I2 = ~0%), respectively. Pooled grade ≥3 hepatologic and hematologic toxicity rates were lower in studies targeting non-intrahepatic lesions than those targeting intrahepatic lesions (hepatologic: 3.3% vs. 17.1%, p = 0.041; hematologic: 3.3% vs. 16.0%, p = 0.078). Gastrointestinal and dermatologic grade ≥3 complications were not significantly different between the subgroups. Regarding OS, concurrent treatment was more beneficial than non-concurrent treatment (odds ratio: 3.3, 95% CI: 1.3–8.59, p = 0.015). One study reported a case of lethal toxicity due to tumor rupture and gastrointestinal bleeding. Concurrent treatment can be considered and applied to target metastatic lesions or local vessel involvement. Intrahepatic lesions should be treated cautiously by considering the target size and hepatic reserve.
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影响因子：
4
作者：
Hozo SP;Djulbegovic B;Hozo I
通讯作者：
Hozo I
影响因子：
158.5
作者：
Llovet, Josep M.;Ricci, Sergio;Bruix, Jordi
通讯作者：
Bruix, Jordi
DOI：
10.1016/j.ijrobp.2015.11.048
发表时间：
2016-03-01
影响因子：
7
作者：
Brade, Anthony M.;Ng, Sylvia;Dawson, Laura A.
通讯作者：
Dawson, Laura A.
影响因子：
13.5
作者：
Burrel, M;Llovet, JM;Bruix, J
通讯作者：
Bruix, J
影响因子：
9.8
作者：
Chalasani, N;Horlander, JC;Lumeng, L
通讯作者：
Lumeng, L