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Article

Is the Concurrent Use of Sorafenib and External Radiotherapy Feasible for Advanced Hepatocellular Carcinoma? A Meta-Analysis

by 1,*,†, 1,†, 2 and 1
1
Department of Radiation Oncology, Ansan Hospital, Korea University Medical College, Ansan 15355, Korea
2
Graduate School of Education, Dongguk University, Seoul 04620, Korea
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
Academic Editor: Hidehito Horinouchi
Cancers 2021, 13(12), 2912; https://doi.org/10.3390/cancers13122912
Received: 19 May 2021 / Revised: 7 June 2021 / Accepted: 9 June 2021 / Published: 10 June 2021
(This article belongs to the Special Issue Radiotherapy and Chemotherapy for Cancers)
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. View Full-Text
Keywords: sorafenib; external beam radiation therapy; concurrent; combined; hepatocellular carcinoma; toxicity sorafenib; external beam radiation therapy; concurrent; combined; hepatocellular carcinoma; toxicity
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MDPI and ACS Style

Rim, C.H.; Park, S.; Shin, I.-S.; Yoon, W.S. Is the Concurrent Use of Sorafenib and External Radiotherapy Feasible for Advanced Hepatocellular Carcinoma? A Meta-Analysis. Cancers 2021, 13, 2912. https://doi.org/10.3390/cancers13122912

AMA Style

Rim CH, Park S, Shin I-S, Yoon WS. Is the Concurrent Use of Sorafenib and External Radiotherapy Feasible for Advanced Hepatocellular Carcinoma? A Meta-Analysis. Cancers. 2021; 13(12):2912. https://doi.org/10.3390/cancers13122912

Chicago/Turabian Style

Rim, Chai Hong, Sunmin Park, In-Soo Shin, and Won Sup Yoon. 2021. "Is the Concurrent Use of Sorafenib and External Radiotherapy Feasible for Advanced Hepatocellular Carcinoma? A Meta-Analysis" Cancers 13, no. 12: 2912. https://doi.org/10.3390/cancers13122912

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