Intensity-modulated radiotherapy (IMRT), an advanced RT technique, is a considerable treatment option for hepatocellular carcinoma (HCC). However, the distinguishing features of IMRT for HCC have not yet been clearly defined. A systematic review was performed according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The PubMed/MedLine, Embase, Cochrane Library, Web of Science, and KoreaMed were used to screen eligible studies focusing on treatment outcomes after IMRT for HCC until 18 April 2023. A total of 1755 HCC patients receiving IMRT among 29 studies from 2009 to 2023 were selected for the meta-analysis. The median proportion of Barcelona Clinic Liver Cancer stage C was 100% (range: 38–100%). Nineteen studies used combined treatment. Pooled rates of response and 1-year local control were 58% (95% confidence interval [CI], 50–65%) and 84% (95% CI, 70–94%), respectively. The median overall survival (OS) was 13 months (range: 5–45 months), and pooled 1- and 3-year OS rates were 59% (95% CI, 52–66%), and 23% (95% CI, 14–33%), respectively. Pooled rates of classic radiation-induced liver disease (RILD), nonclassic RILD, and hepatic toxicity ≥ grade 3 were 2%, 4%, and 4%, respectively. Although most patients had advanced-stage HCC and combined treatment was commonly used, IMRT for HCC showed similar survival to existing RT modalities and relatively low severe toxicity.
调强放射治疗（IMRT）作为一种先进的放射治疗技术，已成为肝细胞癌（HCC）的重要治疗选择。然而，IMRT在HCC治疗中的具体特征尚未得到明确界定。本研究依据系统综述与荟萃分析优先报告条目指南，对截至2023年4月18日发表的HCC患者接受IMRT治疗后疗效的相关研究进行了系统综述。通过检索PubMed/MedLine、Embase、Cochrane Library、Web of Science及KoreaMed数据库，最终纳入2009年至2023年间29项研究，共1755例接受IMRT治疗的HCC患者进行荟萃分析。纳入研究中巴塞罗那临床肝癌分期C期患者的中位比例为100%（范围：38%-100%），其中19项研究采用了联合治疗方案。汇总分析显示：治疗应答率为58%（95%置信区间[CI]：50%-65%），1年局部控制率为84%（95% CI：70%-94%）。中位总生存期为13个月（范围：5-45个月），1年与3年总生存率分别为59%（95% CI：52%-66%）和23%（95% CI：14%-33%）。经典放射性肝病、非经典放射性肝病及≥3级肝毒性的汇总发生率分别为2%、4%和4%。尽管多数患者处于肝癌晚期且常采用联合治疗方案，IMRT治疗HCC仍显示出与现有放射治疗技术相当的生存获益及相对较低的严重毒性反应。
肿瘤(癌症)患者之家