Radiotherapy as valid modality for hepatocellular carcinoma with portal vein tumor thrombosis

Table 1 Systematic meta-analyses evaluating the efficacy of radiotherapy in hepatocellular carcinoma

Ref.	Subject	Study aim	n	CR OR	P value	3 yr OS OR	P value
Meng et al[24]	5 RCT, 12 CCT	TACE + RT vs TACE	1370	2.58	< 0.001	2.75	< 0.001
Liao et al[25]	10 RCT, 18 non-RCT	TACE + RT vs TACE	1223	-	-	2.53	0.001
Huo et al[30]	11 RCT, 14 non-RCT	TACE + RT vs TACE	2577	2.73	< 0.001	1.91	< 0.001
	PVTT subgroup		-	2.38	< 0.001	2.22	< 0.001

CCT: Non-randomized controlled clinical trial; CR: Complete response; OS: Overall survival; PVTT: Portal vein tumor thrombosis; RCT: Randomized controlled trial; TACE: Trans-arterial chemoembolization. RT: Radiotherapy technique.

Table 2 Comparative studies evaluating the effectiveness of radiotherapy in unresectable advanced hepatocellular carcinoma

Ref.	Subject	Study aim	n	1 yr PFS	OS	P value
Eun et al[83]	BCLC C/D	RT vs BSC	29 vs 18	-	45.9 vs 4.8	< 0.001
Yoon et al[35]	Locally advanced	CCRT vs others	106 vs 106	-	11.4 vs 6.6	0.02
Cho et al[27]	BCLC C	TACE + RT vs sorafenib	67 vs 49	-	14.1 vs 3.3	< 0.001
Nakazawa et al[28]	HCC with PVTT	RT vs sorafenib	28 vs 28	-	10.9 vs 4.8	0.002
Li et al[33]	HCC with PVTT	TACE + RT vs TACE	108 vs 108	-	10.9 vs 4.1	< 0.001
Guo et al[23]	Large HCC	TACE + RT vs TACE	89 vs 76		1-yr (%) 64.0 vs 39.9	< 0.001
Tang et al[26]	HCC with PVTT	RT vs surgery	185 vs 186	32.3% vs 42.2%	1-yr (%) 51.6 vs 40.1	0.03
Shiozawa et al[31]	≤ 5-cm solitary HCC	SABR vs RFA	35 vs 38	86.1% vs 85.6%	1-yr (%) 95.2 vs 100	0.08
Wahl et al[34]	Inoperable localized	SABR vs RFA	63 vs 161	LC 97.4% vs 83.6%	1-yr (%) 74.1 vs 69.6	NS

BCLC: Barcelona Clinic Liver Cancer; BCS: Best supportive care; CCRT: Concurrent chemoradiotherapy; HCC: Hepatocellular carcinoma; NS: Not significant; OS: Overall survival; PFS: Progression-free survival; PVTT: Portal vein tumor thrombosis; RFA: Radiofrequency ablation; RT: Radiotherapy; SABR: Stereotactic body radiotherapy; TACE: Trans-catheter arterial chemoembolization.

Table 3 Prospective and retrospective studies applying radiotherapy with or without transcatheter arterial chemo-embolization in hepatocellular carcinoma with portal vein tumor thrombosis

Ref.	Year	Design	Treatment	No.	OR	Median survival, mo		P value
						OR (+)	OR (-)
Tazawa et al[90]	2001	Retrospective	TACE + RT	24	50.0%	9.7	3.8	< 0.001
Yamada et al[91]	2003	Prospective	TACE + RT	19	57.9%	15.4	4.6	0.16
Kim et al[87]	2005	Retrospective	RT	59	45.8%	10.7	5.3	0.05
Nakazawa et al[89]	2007	Retrospective	RT	32	48.0%	13.8	7.0	0.01
Zeng et al[94]	2008	Retrospective	RT	136	57.6%	19.5 (CR)	7.2 (SD)	< 0.001
						10.2 (PR)	3.5 (PD)
Yu et al[93]	2011	Retrospective	RT ± TACE	281	53.8%	22.0	5.0	< 0.001
Yoon et al[92]	2012	Retrospective	TACE + RT	412	39.6%	19.4	7.0	< 0.001
Kim et al[88]	2014	Retrospective	TACE + RT	59	51.0%	NR	7.0	< 0.001

CR: Complete response; NR: Not reported; OR: Objective response; PD: Progressive disease; PR: Partial response; SD: Stable disease.