scholarly journals Stereotactic body radiotherapy vs radiofrequency ablation in the treatment of hepatocellular carcinoma: a meta-analysis

2019 ◽  
Author(s):  
Yang-Xun Pan ◽  
Qian Long ◽  
Dan-Dan Hu ◽  
Yi-Zhen Fu ◽  
Jun-Cheng Wang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Radiofrequency Ablation ◽  
Local Control ◽  
Stereotactic Body Radiotherapy ◽  
Meta Analysis ◽  
Tumor Burden ◽  
Eligibility Criteria ◽  
Post Transplant ◽  
Online Databases ◽  
Significant Difference

Abstract Background Both stereotactic body radiotherapy (SBRT) and radiofrequency ablation (RFA) are effective local treatments for hepatocellular carcinoma (HCC), but whether RFA is superior to SBRT is still controversial. Therefore, we performed a meta-analysis to compare the treatment outcomes of SBRT with RFA as curable or bridge intention.Methods We searched online databases for studies that compared treatment outcome for SBRT and RFA. Eligibility criteria included evaluation of local control, overall survival (OS), transplant rate, and post-transplant pathological necrosis.Results 10 retrospective studies with a total of 2732 patients were included. 2 studies were in favor of SBRT in local control, 2 studies preferred RFA in OS and others reported comparable outcomes for both. SBRT demonstrated significantly higher 1- and 3-year local control than RFA (OR 0.42, 95% CI 0.24 to 0.74, P =0.003; OR 0.54, 95% CI 0.37 to 0.80, P =0.002, respectively). However, SBRT reported significantly shorter 1- and 2-year OS (OR 1.52, 95% CI 1.21 to 1.90, P =0.0003; OR 1.66, 95% CI 1.38 to 2.01, P <0.00001, respectively). As bridge treatment, no significant difference was shown in transplant rate and post-transplant pathological necrosis rate (OR 0.57, 95% CI 0.32 to 1.03, P =0.060; OR 0.49, 95% CI 0.13 to 1.82, P =0.290, respectively).Conclusions This study demonstrates SBRT is able to complete a better local control for HCC than RFA, though the OS is inferior to RFA because of tumor burden or liver profiles of the enrolled studies. Well-designed, randomized, multicenter trials will be required to further investigate the conclusion.

Radiofrequency ablation versus stereotactic body radiotherapy for hepatocellular carcinoma: a meta-analysis

2021 ◽  
Author(s):  
Huimei Zhang ◽  
Na Chang ◽  
Tiantian Han ◽  
Shaodi Ma ◽  
Guangbo Qu ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Radiofrequency Ablation ◽  
Stereotactic Body Radiotherapy ◽  
Literature Search ◽  
Meta Analysis ◽  
Systematic Literature Search ◽  
Local Progression ◽  
Online Databases ◽  
Registration Number

The present meta-analysis was performed to evaluate the efficacy of radiofrequency ablation (RFA) and stereotactic body radiotherapy (SBRT) in hepatocellular carcinoma (HCC) patients. A systematic literature search was conducted of online databases prior to February 21, 2021. Eleven articles involving 8429 patients were included. The pooled hazard ratio for overall survival (OS) of RFA versus SBRT was 0.79 (p < 0.001). Statistically significant differences were found in the 1-, 2-, 3-, 4- and 5-year pooled OS and freedom from local progression (FFLP) rates between the two groups, favoring the RFA arms. However, the pooled local control (LC) rates were higher in the SBRT arm. RFA provided better OS and FFLP for treating HCC, while SBRT achieved superior LC. PROSPERO registration number: CRD42020207877 .

scholarly journals Radiofrequency ablation versus hepatic resection for recurrent hepatocellular carcinoma: an updated meta-analysis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Daopeng Yang ◽  
Bowen Zhuang ◽  
Yan Wang ◽  
Xiaoyan Xie ◽  
Xiaohua Xie
Keyword(s):  
Hepatocellular Carcinoma ◽  
Radiofrequency Ablation ◽  
Hepatic Resection ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Recurrent Hepatocellular Carcinoma ◽  
Major Complications ◽  
Alternative Treatment Option ◽  
Significant Difference

Abstract Background The clinical benefits of treatment with radiofrequency ablation (RFA) and repeat hepatic resection (RHR) for recurrent hepatocellular carcinoma (RHCC) remain controversial. This meta-analysis aims to evaluate the outcomes and major complications of RFA versus RHR in patients with early-stage RHCC. Methods PubMed, Embase, Web of Science and the Cochrane Library were systematically searched for comparative studies on the evaluation of RHR versus RFA for RHCC. The primary outcome was overall survival (OS), and the secondary outcomes were progression-free survival (PFS) and major complications. Meta-analysis was performed using a random-effects model or fixed-effects model, and heterogeneity was tested by the Cochran Q statistic. Results Ten studies with 1612 patients (RHR = 654, RFA = 958) were included in the meta-analysis. The meta-analysis showed that RHR had superior OS (HR 0.77, 95% CI =0.65–0.92, P = 0.004) and PFS (HR 0.81, 95% CI =0.67–0.98, P = 0.027) compared to RFA, whereas major complications may be less frequent in the RFA group (OR 0.15, 95% CI = 0.06–0.39, P < 0.001). In the subgroup analysis of patients with single RHCC ≤3 cm, OS (HR 1.03, 95% CI =0.69–1.52, P = 0.897) and PFS (HR 0.99, 95% CI = 0.71–1.37, P = 0.929) showed no significant differences in the comparison of RHR and RFA. In single RHCC> 3 cm and ≤ 5 cm, RFA showed an increased mortality in terms of OS (HR 0.57, 95% CI = 0.37–0.89, P = 0.014). Conclusion RHR offers a longer OS and PFS than RFA for patients with RHCC, but no statistically significant difference was observed for single RHCC ≤3 cm. The advantages of fewer major complications may render RFA an alternative treatment option for selected patients.

Use of radiofrequency ablation and stereotactic body radiotherapy for the treatment of hepatocellular carcinoma: An analysis of the SEER-Medicare database.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 463-463 ◽  
Author(s):  
Mary Uan-Sian Feng ◽  
Vincent D. Marshall ◽  
Neehar Parikh
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Radiofrequency Ablation ◽  
Stereotactic Body Radiotherapy ◽  
Early Stage ◽  
Rank Test ◽  
The West ◽  
Liver Decompensation ◽  
Significant Difference ◽  
The Us

463 Background: Hepatocellular carcinoma (HCC) is an increasingly common and highly morbid malignancy worldwide, including the US. For early stage patients ablative strategies are important potentially curative treatment options. Stereotactic body radiotherapy (SBRT) has emerged as a promising non-surgical ablative therapy, although it is technically demanding and its comparison with radiofrequency ablation (RFA) remains confined to a single institution retrospective review. We queried the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database to assess RFA and SBRT use in the US. Methods: We identified patients greater than 65 years old who were diagnosed from 2004-11 with stage I or II HCC and treated with RFA or SBRT. Survival analysis was conducted using Kaplan-Meier curves and log rank test. Factors associated with overall survival (OS) and early ( ≤ 90 day) hospital admission post-treatment were identified using propensity score (PS) adjusted multivariate analysis. Results: 825 patients were identified, 747 treated with RFA and 78 SBRT. 22 pts received both treatments and were excluded from this analysis. The mean Charlson comorbidity index was 1.0±1.1. Median age was 74, range 66-90. Patients who received RFA were more likely to live in the West and have liver decompensation. Patients who received SBRT were more likely to be white and treated in the Midwest. After using PS matching there were 78 in each cohort. In these patients, mean overall survival (OS) was 2.25 and 2.04 yrs for RFA and SBRT, p = 0.06. Younger age, lack of liver decompensation, treatment in the West, and liver transplantation were associated with longer OS, HR 0.96, p = 0.05; HR 0.37, p = 0.002; HR 0.57, p = 0.04; HR 0.18, p = 0.008, respectively. 90 day hospitalization rates did not differ between treatments; only liver decompensation was predictive of hospitalization, OR 3.33, p = 0.032. Conclusions: In a national cohort of early stage HCC patients, treatment with RFA vs SBRT resulted in no significant difference in OS. SBRT appears to be a comparable ablative strategy to RFA in this population. This highlights the need for a randomized trial comparing these two modalities.

Stereotactic Body Radiotherapy Combined with Transcatheter Arterial Chemoembolization versus Stereotactic Body Radiotherapy Alone as the First-Line Treatment for Unresectable Hepatocellular Carcinoma: A Meta-Analysis and Systematic Review

Chemotherapy ◽  
2019 ◽  
Vol 64 (5-6) ◽  
pp. 248-258 ◽  
Author(s):  
Jiani Zhao ◽  
Lianli Zeng ◽  
Qian Wu ◽  
Li Wang ◽  
Jun Lei ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Incidence Rate ◽  
Stereotactic Body Radiotherapy ◽  
Transcatheter Arterial Chemoembolization ◽  
Meta Analysis ◽  
Cochrane Library ◽  
First Line ◽  
Unresectable Hepatocellular Carcinoma ◽  
Significant Difference ◽  
Arterial Chemoembolization

Background: The superiority of stereotactic body radiotherapy (SBRT) combined with transcatheter arterial chemoembolization (TACE) compared to SBRT alone as the first-line therapy for unresectable hepatocellular carcinoma (HCC) remains unclear. We conducted this meta-analysis to compare the efficiency and safety of SBRT combined with TACE (ST group) and SBRT alone (SA group). Methods: We searched PubMed, Ovid Medline, Web of Science, Scopus, The Cochrane Library, ScienceDirect, EMBASE, Google Scholar, and CNKI (China National Knowledge Infrastructure) for related studies. We analyzed overall survival (OS), local control survival (LCS), progression-free survival (PFS), the response rate and adverse effects (AEs) between the 2 groups. Results: Ten articles were included, with a total of 980 patients. The results showed that the ST (SBRT + TACE) group had a longer OS (95% CIs 0.60–0.85, p = 0.0002), a higher 5-year OS rate (95% CI 1.01–2.04, p = 0.04), a higher rate of complete response (95% CI 1.08–1.90, p = 0.01), and a higher disease control rate (95% CI 1.02–1.16, p = 0.02) than the SA (SBRT alone) group. No significant difference was found in LCS, PFS and total AEs of all grades and grades 3–5 AEs between the 2 groups. In the subgroup analysis, the patients with HCC + PVTT or treated with SBRT followed by TACE in the ST group had the same OS as those in the SA group, and the patients in the ST group had a higher incidence rate of leukopenia and fever than those in the SA group. Conclusion: SBRT + TACE appears to be more effective than SBRT alone in treating unresectable HCC. However, its higher incidence rate of leukopenia and fever need to be monitored.

scholarly journals Meta-analysis of Percutaneous vs. Surgical Approaches Radiofrequency Ablation in Hepatocellular Carcinoma

2022 ◽  
Vol 8 ◽  
Author(s):  
Xiaozhun Huang ◽  
Yibin Liu ◽  
Lin Xu ◽  
Teng Ma ◽  
Xin Yin ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Radiofrequency Ablation ◽  
Perioperative Complications ◽  
Meta Analysis ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Analysis Data ◽  
Cochrane Library ◽  
Surgical Approaches ◽  
Significant Difference

Background: Radiofrequency ablation (RFA) is a curative modality for hepatocellular carcinoma (HCC) patients who are not suitable for resection. It remains controversial whether a surgical or percutaneous approach is more appropriate for HCC.Method: A search was performed on the PubMed, Web of Science, Embase, and Cochrane Library databases from the date of database inception until April 17, 2021. Studies reporting outcomes of comparisons between surgical RFA (SRFA) and percutaneous RFA (PRFA) were included in this study. The meta-analysis was performed using the Review Manager 5.3 and Stata 12.0 software.Result: A total of 10 retrospective studies containing 12 cohorts, involving 740 patients in the PRFA group and 512 patients in the SRFA group, were selected. Although the tumor size in PRFA group was smaller than the SRFA group (p = 0.007), there was no significant difference in complete ablation rate between the SRFA and PRFA groups (95.63% and 97.33%, respectively; Odds ratio [OR], 0.56; 95% confidence intervals [CI], 0.26–1.24; p = 0.15). However, the SRFA group showed a significantly lower local tumor recurrence than the PRFA group in the sensitivity analysis (28.7% in the PRFA group and 21.79% in the SRFA group, respectively; OR, 1.84; 95% CI, 1.14–2.95; p = 0.01). Pooled analysis data showed that the rate of severe perioperative complications did not differ significantly between the PRFA and SRFA groups (14.28% and 12.11%, respectively; OR, 1.30; 95% CI, 0.67-2.53; p = 0.44). There was no significant difference in the 1-, 3-, and 5-year overall survival rates, as well as the 1- and 3-year disease-free survival (DFS) between the PRFA and SRFA groups. The 5-year DFS of the PRFA group was significantly lower than the SRFA group (hazard ratio 0.73; 95% CI 0.54–0.99).Conclusion: Based on our meta-analysis, the surgical route was superior to PRFA in terms of local control rate. Furthermore, the surgical approach did not increase the risk of major complications.

scholarly journals Radiofrequency Ablation Versus Hepatic Resection for Recurrent Hepatocellular Carcinoma: An Updated Meta-analysis

2020 ◽  
Author(s):  
Daopeng Yang ◽  
Bowen Zhuang ◽  
Yan Wang ◽  
Xiaoyan Xie ◽  
Xiaohua Xie
Keyword(s):  
Hepatocellular Carcinoma ◽  
Radiofrequency Ablation ◽  
Hepatic Resection ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Recurrent Hepatocellular Carcinoma ◽  
Major Complications ◽  
Alternative Treatment Option ◽  
Significant Difference

Abstract Background:The clinical benefits of treatment with radiofrequency ablation (RFA) and repeat hepatic resection (RHR) for recurrent hepatocellular carcinoma (RHCC) remain controversial. This meta-analysis aims to evaluate the outcomes and major complications of RFA versus RHR in patients with early-stage RHCC.Methods:PubMed, Embase, Web of Science and the Cochrane Library were systematically searched for comparative studies on the evaluation of RHR versus RFA for RHCC. The primary outcome was overall survival (OS), and the secondary outcomes were progression-free survival (PFS) and major complications. Meta-analysis was performed using a random-effects model or fixed-effects model, and heterogeneity was tested by the Cochran Q statistic. Results:Ten studies with 1612 patients (RHR = 654, RFA = 958) were included in the meta-analysis. The meta-analysis showed that RHR had superior OS (HR 0.77, 95% CI =0.65-0.92, P=0.004) and PFS (HR 0.81, 95% CI =0.67-0.98, P=0.027) compared to RFA, whereas major complications may be less frequent in the RFA group (OR 0.15, 95% CI = 0.06-0.39, P<0.001). In the subgroup analysis of patients with single RHCC ≤ 3 cm, OS (HR 1.03, 95% CI =0.69-1.52, P=0.897) and PFS (HR 0.99, 95% CI=0.71-1.37, P=0.929) showed no significant differences in the comparison of RHR and RFA. In single RHCC>3 cm and ≤5 cm, RFA showed an increased mortality in terms of OS (HR 0.57, 95% CI=0.37-0.89, P=0.014).Conclusion:RHR offers a longer OS and PFS than RFA for patients with RHCC, but no statistically significant difference was observed for single RHCC ≤ 3 cm. The advantages of fewer major complications may render RFA an alternative treatment option for selected patients.

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