Transcatheter arterial chemoembolization in combination with radiotherapy for unresectable hepatocellular carcinoma: a systematic review and meta-analysis

Radiother Oncol. 2009 Aug;92(2):184-94. doi: 10.1016/j.radonc.2008.11.002. Epub 2008 Nov 29.


Background and purpose: To evaluate the efficacy and safety of transcatheter arterial chemoembolization (TACE) plus radiotherapy (RT) for unresectable hepatocellular carcinoma (UHCC) using meta-analysis of data from the literature involving available randomized controlled trials of TACE in combination with RT compared with that of TACE alone (Therapy I versus II) in treating UHCC.

Material and methods: We searched the Cochrane Library, MEDLINE, CENTRAL, EMBASE, CBMdisc, and CNKI as well as employing manual searches. Meta-analysis was performed on the results of homogeneous studies. Analyses subdivided by study design were also performed.

Results: We found 17 trials involving 1476 patients. 5 of total were Randomized Controlled Trials (RCTs) and 12 were Non-randomized Controlled Clinical Trials (CCTs). In terms of quality, 5 RCTs were graded B, and 12 CCTs were graded C. Our results showed that Therapy I, compared with Therapy II, significantly improved the survival and the tumor response of patients, and was thus more therapeutically beneficial. Serious adverse events were not increased exception for total bilirubin (TB) level.

Conclusions: Therapy I was more therapeutically beneficial. However, considering the strength of the evidence, additional randomized controlled trials are needed before Therapy I can be recommended routinely.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Alanine Transaminase / blood
  • Bilirubin / blood
  • Carcinoma, Hepatocellular / mortality
  • Carcinoma, Hepatocellular / therapy*
  • Chemoembolization, Therapeutic* / adverse effects
  • Combined Modality Therapy
  • Humans
  • Liver Neoplasms / mortality
  • Liver Neoplasms / therapy*
  • Publication Bias


  • Alanine Transaminase
  • Bilirubin