Systematic review of adjuvant external beam radiotherapy for hepatocellular carcinoma following radical hepatectomy

Wang, Lei; Lü, Qin; Ke, Qiao; Ji, Hongbing; Wang, Junxin

doi:10.1016/j.radonc.2022.08.019

Cited by 8 publications

(3 citation statements)

References 57 publications

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“… 34–36 Furthermore, the utilization of radiotherapy and immune checkpoint inhibitors has also been reported in the postoperative management of HCC. 37 , 38 In this study, we observed that narrow RM patients were more likely to receive adjuvant TACE, as previously reported. 21 This finding suggests that a wide RM may not be the sole optimal approach, as subsequent adjuvant treatment can be utilized to complement the potential risks associated with a narrow RM.…”

Section: Discussionsupporting

confidence: 86%

Resection Margin Width Does Not Influence the Prognosis of Solitary Hepatocellular Carcinoma After Anatomic Resection: A Real-World Study from China

Ke¹,

Guo²,

He³

et al. 2023

JHC

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Purpose The influence of resection margin (RM) width on the prognosis of solitary hepatocellular carcinoma (HCC) following anatomical resection (AR) has yet to be determined. Therefore, we conducted a real-world study to identify the optimal RM width and assess its impact on the outcomes of solitary HCC patients undergoing AR. Methods The data pertaining to patients diagnosed with solitary HCC who underwent AR between December 2012 and December 2015 were retrospectively collected. The optimal cutoff value for the width of the RM was determined using X-tile software. The Kaplan-Meier method was utilized to compare the overall survival (OS) and disease-free survival (DFS) between the narrow and wide RM groups. Additionally, propensity score matching (PSM) was performed to minimize potential bias in the data. Results Of the 1033 patients who met the inclusion criteria, 293 (28.4%) were categorized into the narrow RM group (≤4 mm) and 740 (71.6%) into the wide RM group (> 4mm). Before and after PSM, there were no significant differences in OS and DFS between the two groups (before PSM: OS, HR=0.78, P =0.071; DFS, HR=0.95, P =0.620; after PSM: OS, HR=0.77, P =0.150; DFS, HR=0.90, P =0.470). Multivariate analysis demonstrated that RM width was not an independent risk factor for DFS and OS both before and after PSM (all P >0.05). However, subgroup analyses revealed that patients with ALBI grade 1, absence of cirrhosis, and AJCC stage II significantly benefited from wide RM in OS (all P < 0.05). Similarly, patients without HBV infection and absence of cirrhosis also exhibited significant benefits from wide RM in DFS (both P < 0.05). Conclusion In patients with solitary HCC undergoing AR, the width of the RM does not appear to have a significant impact on their prognosis. However, in certain selected patients, a wider RM may confer benefits.

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Section: Discussionsupporting

confidence: 86%

Resection Margin Width Does Not Influence the Prognosis of Solitary Hepatocellular Carcinoma After Anatomic Resection: A Real-World Study from China

Ke¹,

Guo²,

He³

et al. 2023

JHC

Self Cite

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“…In the last decade, several retrospective and prospective studies have demonstrated its efficacy in improving prognosis, especially among patients with centrally located HCC, narrow margin, MVI, and portal vein tumor thrombus [16] , [17] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] . A recent systematic review showed that PORT decreased the risk of recurrence and conferred an oncological benefit for patients with high-risk recurrent HCC after hepatectomy but without increasing severe radiation-related adverse events [30] . As for the study on PORT following NH, Shi et al [23] conducted a study in HCC patients with MVI-positive who received marginal resection (<1.0 mm).…”

Section: Discussionmentioning

confidence: 99%

Postoperative radiotherapy following null-margin hepatectomy in patients with hepatocellular carcinoma adhering to the major vessels: A propensity score-matched survival analysis cohort study

Long,

Chen,

Zheng

et al. 2024

Clinical and Translational Radiation Oncology

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“… 74 A systematic review including 10 studies (three randomized trials, one phase II trial, and six retrospective comparative studies) found adjuvant external beam radiotherapy significantly improved RFS and OS compared with hepatectomy alone. 75 Therefore, the current limited evidence showed that adjuvant radiotherapy was a safe and effective measure to prevent HCC recurrence.…”

Section: Unanswered Questions Of Adjuvant Treatmentmentioning

confidence: 99%

Adjuvant Therapy for Hepatocellular Carcinoma After Curative Treatment: Several Unanswered Questions

Li,

Pan

et al. 2024

J Clin Transl Hepatol

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Most patients with hepatocellular carcinoma (HCC) have a poor prognosis. Hepatectomy and local ablation are the main curative treatments for HCC. Nevertheless, the recurrence rate after hepatectomy or ablation is up to 70%, which seriously affects patient prognosis. Several adjuvant therapies have been explored to reduce postoperative recurrence. However, although a variety of adjuvant therapies have been shown to reduce the recurrence rate and improve overall survival, a standard consensus of national HCC guidelines for adjuvant treatment is lacking. Therefore, there are significant differences in the recommendations for adjuvant therapy for HCC between the Eastern and Western guidelines. A variety of adjuvant treatment methods, such as antiviral therapy, transarterial chemoembolization or traditional Chinese medicine, are recommended by the Chinese HCC guidelines. However, Western guidelines make few recommendations other than antiviral therapy. Adjuvant immune checkpoint inhibitors are recommended only in the recently updated American Association for the Study of Liver Diseases guidelines. This review summarized the existing adjuvant therapy options after curative hepatectomy or ablation and discusses several important dilemmas of adjuvant treatments.

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Systematic review of adjuvant external beam radiotherapy for hepatocellular carcinoma following radical hepatectomy

Cited by 8 publications

References 57 publications

Resection Margin Width Does Not Influence the Prognosis of Solitary Hepatocellular Carcinoma After Anatomic Resection: A Real-World Study from China

Resection Margin Width Does Not Influence the Prognosis of Solitary Hepatocellular Carcinoma After Anatomic Resection: A Real-World Study from China

Postoperative radiotherapy following null-margin hepatectomy in patients with hepatocellular carcinoma adhering to the major vessels: A propensity score-matched survival analysis cohort study

Adjuvant Therapy for Hepatocellular Carcinoma After Curative Treatment: Several Unanswered Questions

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