Meta-analysis Of The Efficacy And Safety Of Radiotherapy Combined With TACE In The Treatment Of Middle And Advanced Liver Caner

Background: The incidence of primary hepatic carcinoma is the fifth and fourth in the world and China respectively.It is the second leading cause of cancer-related death in the world and the third most common cause of cancer-related death in China.The liver cancer had occult onset with no obvious signs in the early stage.The expression of invasion and metastasis in the middle and late stage means losing the opportunity of operation.Hepatic arterial chemoembolization(Transcatheter arterial chemoembolization,TACE)is one of the main methods for the treatment of advanced liver cancer.Because the liver is a double blood supply organ,only transarterial chemoembolization has the deficiency of incomplete tumor necrosis and easy recurrence.Radiotherapy as a non-invasive treatment method,has become an important method of non-surgical treatment of liver cancer in recent years with the development of radiotherapy equipment and technology.It has been reported that radiotherapy combined with TACE is more effective than TACE alone in the treatment of primary liver cancer,but the incidence of adverse reactions such as gastric ulcer,duodenal ulcer and abnormal liver function is also higher.There was no significant difference in vomiting and leukopenia between the two groups.However,for the advanced liver cancer and the patient loss of surgical opportunity,there is no evidence-based medical report on whether radiotherapy combined with TACE is superior to TACE alone in efficacy and safety.Objective: Evaluate the efficacy and safety of radiotherapy combined with TACE in the treatment of middle and advanced liver cancer.Methods: From January 2007 to December 2018,a computer search was used to retrieve the clinical study on the efficacy and safety of radiotherapy combined with TACE in the treatment of advanced liver cancer compared with TACE alone in the databases of Pub Med,Embase,Cochrane,Clinical Trails,CNKI,Wanfang and VIP.Rev Man 5.3 was used for Meta analysis of the included studies,and Egger method was used to analyze publication bias.Results: A total of 1574 patients with advanced liver cancer were included in 21 studies,all of which were Randomized controlled trials(RCT).The objective effective rate(ORR)of radiotherapy combined with TACE group was 77.06%,which was better than that of TACE group 52.48%,(P < 0.05);The 1-year,2-year and 3-year survival rates in radiotherapy combined with TACE group were 74.63%,50.54% and 33.55%,respectively,which were significantly higher than those in TACE alone,52.76%,27.66% and 16.38%,(P < 0.05).Their OR and 95%CI were 2.69,[1.98,3.65],2.65,[1.95,3.62] and 2.52,[1.70,3.74];P < 0.001.The most common adverse reactions were leukopenia,impaired liver function,fever and gastrointestinal tract reaction.Subgroup analysis: 1)Compare with the ORR and 1-3 year survival rate,the subgroup which has same number of TACE treatments show the priority to the subgroup which doesn't have the same number of TACE treatments.2)The ORR of X-ray radiation subgroup was higher than that of ?-ray radiation subgroup.3)For the unresectable liver caner,the subgroup including stage I shows the priority to the subgroup without stage I in ORR and 1-year survival rate;but the subgroup including stage I do not shows the priority to the subgroup without stage I in 2-year and 3-year survival rates.Conclusion: Radiotherapy combined with TACE in the treatment of advanced liver cancer in the short term,survival rate and safety were better than the treatment of TACE alone,and the adverse reactions can be tolerated.And the conclusion of subgroup analysis: 1)Radiation therapy on the basis of TACE therapy has a better effect on tumor focus reduction or regression,and can prolong the short and long term survival time of the patients.2)Because X-ray radiotherapy is more widely used in our country and has rich experience accumulation and precision equipment,its curative effect and short-term effective rate are higher than the possibility of ?-ray radiotherapy.3)Non-operative liver cancer with stage I may have better short-term curative effect on the reduction or regression of tumor focus after radiotherapy,but the long-term survival rate is lower than that of non-operative liver cancer without stage I due to the influence of tumor location and limited treatment of patients themselves.