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. 2023 Oct;23(6):2141-2150.
doi: 10.1007/s10238-023-00997-3. Epub 2023 Feb 3.

Comparison of the efficacy and safety of selective internal radiotherapy and sorafenib alone or combined for hepatocellular carcinoma: a systematic review and Bayesian network meta-analysis

Hao Zeng #  1 , Chengyuan Zhou #  2 , Xiaojing Chen  1 , Lanxin Hu  1 , Ke Su  1 , Lu Guo  3 , Yunwei Han  4
Affiliations

Comparison of the efficacy and safety of selective internal radiotherapy and sorafenib alone or combined for hepatocellular carcinoma: a systematic review and Bayesian network meta-analysis

Hao Zeng et al. Clin Exp Med. 2023 Oct.

Abstract

Background: Selective internal radiation therapy (SIRT) is a developing technique and its efficacy and modality of application in hepatocellular carcinoma (HCC) are still controversial. This network meta-analysis aims to determine whether the efficacy and safety of SIRT alone and in combination are superior to that of sorafenib.

Methods: Four databases (PubMed, Embase, Cochrane Library, and Web of Science) were searched before August 2022. Cochrane Randomized Trial Risk of Bias Assessment Tool and the Newcastle-Ottawa scale were used to assess the quality. The outcomes of interest included overall survival (OS), progression-free survival (PFS), and adverse events (AEs).

Results: A total of 9 eligible trials involving 1954 patients were included, and SIRT ranked first among the three treatment modalities in terms of both OS (probability, 52.3%) and PFS (probability, 68.6%). The combination of SIRT and sorafenib did not improve OS or PFS in patients with HCC. Although the combination of SIRT and sorafenib did not raise the risk of grade 3 or higher AEs, it may have introduced more AEs than either alone.

Conclusions: SIRT alone was found to be superior to sorafenib and the combination of the two in improving OS or PFS in patients with non-surgical HCC, especially in patients with combined portal vein tumor thrombus. The AEs induced by SIRT were different from those of sorafenib, but the overall toxicity was manageable, the combination of the two may cause an increase in the types of AEs that occur.

Keywords: Liver cancer; Network meta-analysis; Non-surgical treatments; Transarterial radioembolization; Yttrium-90.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
Forest plot of pairwise meta-analysis using a random effects model for overall survival (OS) and progression-free survival (PFS). The dotted line indicates the overall, pooled, estimate. The size of the shaded gray boxes indicates the relative weight of the study. CI: confidence interval
Fig. 3
Fig. 3
Subgroup analysis of randomized controlled trials (RCTs) (1.2). Overall survival (OS) for the sub-population from the Asian–Pacific region (1.3). OS for the sub-population with portal vein thrombus (PVTT) (1.4). CI: confidence interval
Fig. 4
Fig. 4
Network plot for overall survival (OS) (A) and progression-free survival (PFS) (B): The thickness of the connecting line corresponds to the number of trials between comparators. SIRT_Sorafenib: the combination of selective internal radiation therapy (SIRT) and Sorafenib
Fig. 5
Fig. 5
A Forest plot of Bayesian network meta-analysis using a random effects model for overall survival (OS) and progression-free survival (PFS). B Percent bar chart of overall survival (OS) and progression-free survival (PFS): Percent bar chart showing the likelihood of selective internal radiation therapy (SIRT), the combination of SIRT and Sorafenib (SIRT_Sorafenib), and Sorafenib being the most, second most, and least efficacious interventions in terms of OS in patients with hepatocellular carcinoma (left), and the likelihood of SIRT, Sorafenib, and SIRT_Sorafenib being the most, second most, and least efficacious interventions in terms of PFS in patients with hepatocellular carcinoma (right)
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