Radiotherapy for Liver Cancer: An International Multi-Centre Pooled Analysis of 925 Cases

PURPOSE/OBJECTIVE(S)

Primary and secondary liver cancer incidence is growing and has a poor prognosis. The standard use of radiation has been hampered by studies with a wide range of patients, different management protocols and varied outcomes. To overcome this heterogeneity in the literature, larger and higher-level trials are warranted, but, so far, have been difficult to implement. Therefore, pooled analyses may offer the best way to determine the benefit of radiation, identify treatment parameters needed to optimize treatment techniques, and identify patient factors that allow for better patient selection.

MATERIALS/METHODS

Patients with liver cancer treated by radiotherapy at centers in Canada, United States and Australia was pooled. Patient and treatment characteristics were noted, as well as the clinical outcomes of local control within 1 year, recurrence and mortality. Stepwise Cox proportional hazards models were used to identify significant predictors for recurrence and mortality. Patients were stratified by center, and primary versus metastatic disease.

RESULTS

A total of 925 patients were included in this study. Mean age was 67 years, and 45% had a primary diagnosis of hepatocellular carcinoma. 1-year local control rate was 80%. Median survival was 1.8 years (1.9 years for primary liver cancer, and 1.4 years for metastatic liver cancer). Higher total dose and BED was associated with better survival. Median time to recurrence was 1.5 years. Higher total dose was associated with lower risk of recurrence CONCLUSION: As one of the largest pooled analyses in hepatic cancer, this international multi-center study provides pragmatic data on clinical outcomes of patients receiving radiotherapy for liver cancer. This database may assist in better selection of patients for future studies and answer questions such as what is the optimal dose and which patients benefit from treatment.

Treatment Modalities to Manage Hepatocellular Carcinoma Patients with Portal Vein Thrombus: A Systematic Review and Meta-Analysis

PURPOSE/OBJECTIVE(S)

Patients with hepatocellular carcinoma (HCC) and portal vein thrombosis (PVT) have poor outcomes and an effective treatment strategy has not been established. The aim of this review is to compare the effectiveness of available treatment options in preventing mortality.

MATERIALS/METHODS

A search was conducted in PubMed, EMBASE and Cochrane CENTRAL from 2007 to 2022. Articles were screened to identify studies of HCC patients with PVT that reported on all-cause mortality using radical intent treatments. Study quality was assessed using the Cochrane Risk of Bias in Non-Randomized Studies of Interventions tool (ROBINS-1). Mortality rates at prespecified timepoints between 6 and 24 months were extracted and summarized using a random-effects DerSimonian-Laird model. This review was registered a priori on PROSPERO (CRD42022290708).

RESULTS

The impact of radiotherapy (RT) on overall survival (OS) is similar to all other treatments including sorafenib. When comparing sorafenib to local modalities (Y90 and RT), the local treatments had a better OS (OR 2.20, 95% CI: 1.11 - 4.39), but this difference disappeared after 6-months. Indeed, within 6 months, Y90 provided the best OS. No significant differences were noticed from 12 to 24 months. Combination treatments appeared to provide a significant additional OS benefit with TACE+RT having an improved OS over TACE alone and RT alone, with the benefit extending to 24 months.

CONCLUSION

this analysis of HCC patients with PVT reports on six cohorts, with a total sample size of 2,356 patients. The addition of localized treatment to systemic treatment appears to improve survival. Combining TACE and RT was also better than either modality alone. Further investigations should be conducted, to further understand the role of localized treatments.