Background
Systematic review and meta-analysis. Compared outcomes of TACE combined with SBRT vs TACE alone for hepatocellular carcinoma. Searched MEDLINE, Cochrane, and EMBASE databases for studies reporting time-to-event outcomes. Included retrospective and prospective comparative and non-comparative studies with separate TACE and TACE+SBRT groups. This is a quantitative synthesis, not a primary trial.
Interventions and follow up
Arm A: TACE + SBRT (concurrent or sequential)
Arm B: TACE alone
Primary endpoint: Overall survival (pooled hazard ratio); secondary: local control, tumor response
mFollow up: Variable across included studie
Arm B: TACE alone
Primary endpoint: Overall survival (pooled hazard ratio); secondary: local control, tumor response
mFollow up: Variable across included studie
Results
OS benefit (TACE+SBRT vs TACE alone): Significantly improved with combined therapy — pooled HR favoring TACE+SBRT
Local control: Higher with TACE+SBRT
ORR: Higher with TACE+SBRT combination
Local control: Higher with TACE+SBRT
ORR: Higher with TACE+SBRT combination
Adverse events
Main adverse events: TACE+SBRT toxicity was similar to or modestly higher than TACE alone; no significant increase in serious adverse events in the combined approach across analyzed studies.
Conclusions
Meta-analysis demonstrates that TACE combined with SBRT significantly improves overall survival and local control compared to TACE alone for HCC, supporting the sequential TACE → SBRT strategy as a superior approach to TACE monotherapy for patients with unresectable HCC.
Key Limitations
Key Limitations: Pooled analysis of heterogeneous studies with varying patient populations, SBRT doses, TACE protocols, and follow-up durations. No included randomized controlled trial comparing TACE vs TACE+SBRT at the time of publication — all comparative data from retrospective or non-randomized studies. Publication bias likely. Cannot determine optimal sequencing, number of TACE cycles, or patient selection criteria from pooled data.
Clinical Context
This meta-analysis helped establish TACE+SBRT as a preferred combination for selected HCC patients — particularly those with intermediate/advanced disease (BCLC B) not eligible for curative therapies. Subsequent prospective data (Yoon JAMA Oncol 2018, Korean randomized phase 2) have provided higher-quality evidence. The combination is especially valuable for HCC with portal vein tumor thrombosis or TACE-refractory/incomplete responders.
References