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Comparison of radiofrequency ablation and ablative external radiotherapy for the treatment of intrahepatic malignancies: A hybrid meta-analysis

 Chai Hong Rim  ;  Jung Sue Lee  ;  Soo Yeon Kim  ;  Jinsil Seong 
 JHEP REPORTS, Vol.5(1) : 100594, 2023-01 
Journal Title
Issue Date
ASCO, American Society of Clinical Oncology ; ASTRO, American Society for Radiation Oncology ; CIRSE, cardiovascular and interventional radiological society of Europe ; CRC, colorectal cancer ; EBRT, external beam radiation therapy ; EQD2, Equivalent dose, 2 Gy per Fraction ; External beam radiation therapy ; HCC, hepatocellular carcinoma ; HFRT, hypofractionated radiotherapy ; IPTW, inverse probability of treatment weighting ; Intrahepatic malignancy ; LC, local control ; LT, liver transplantation ; Liver cancer ; MWA, microwave ablation ; NCDB, national cancer database ; OS, overall survival ; P, prospective ; PBT, proton beam therapy ; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses ; PSM, propensity score matching ; R, retrospective ; RCT, randomised controlled trial ; RFA, radiofrequency ablation ; RT, radiotherapy ; Radiofrequency ablation ; SBRT, stereotactic body radiotherapy ; TACE, transarterial chemoembolisation
Background & aims: Radiofrequency ablation (RFA) and ablative external beam radiotherapy (ablative RT) are commonly used to treat small intrahepatic malignancies. We meta-analysed oncologic outcomes and systematically reviewed the clinical consideration of tumour location and size.

Methods: PubMed, Medline, Embase, and Cochrane Library databases were searched on February 24, 2022. Studies comparing RFA and ablative RT, providing one of the endpoints (local control or survival), and encompassing ≥5 patients in each arm were included.

Results: Twenty-one studies involving 4,638 patients were included. Regarding survival, the odds ratio (OR) was 1.204 (p = 0.194, favouring RFA, not statistically significant) among all studies, 1.253 (p = 0.153) among hepatocellular carcinoma (HCC) studies, and 1.002 (p = 0.996) among colorectal cancer metastasis studies. Regarding local control, the OR was 0.458 (p <0.001, favouring ablative RT) among all studies, 0.452 (p <0.001) among HCC studies, favouring the ablative RT arm, and 0.649 (p = 0.484) among colorectal cancer metastasis studies. Pooled 1- and 2-year survival rates for HCC studies were 91.8% and 77.7% after RFA, and 89.0% and 76.0% after ablative RT, respectively; and for metastasis studies were 88.2% and 66.4% after RFA and 82.7% and 60.6% after RT, respectively. Literature analysis suggests that ablative RT can be more effective than RFA for tumours larger than 2-3 cm or for specific sublocations in the liver (e.g. subphrenic or perivascular sites), with moderate quality of evidence (reference to the grading system of the American Society for Radiation Oncology Primary Liver Cancer Clinical Guidelines). The pooled grade ≥3 complication rates were 2.9% and 2.8% in the RFA and ablative RT arms, respectively (p = 0.952).

Conclusions: Our study shows that ablative RT can yield oncologic outcomes similar to RFA, and suggests that it can be more effective for the treatment of tumours in locations where RFA is difficult to perform or for large-sized tumours.

Systematic review registration: This study was registered with PROSPERO (Protocol No: CRD42022332997).

Impact and implications: Radiofrequency ablation (RFA) and ablative radiotherapy (RT) are non-surgical modalities for the treatment of small intrahepatic malignancies. Ablative RT showed oncologic outcomes at least similar to those of RFA, and was more effective at specific locations (e.g. perivascular or subphrenic locations).
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1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Seong, Jin Sil(성진실) ORCID logo https://orcid.org/0000-0003-1794-5951
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