Abstract Aim Stereotactic body radiotherapy (SBRT) is an emerging treatment for hepatocellular carcinoma (HCC) and has shown excellent local control (LC), as has radiofrequency ablation (RFA). As no randomized controlled trial has compared SBRT and RFA for HCC, data from a propensity score matched study (PSMS) are valuable. However, the results varied greatly and depended on composing factors of Barcelona Clinic Liver Cancer staging (BCLC‐factors) adjusted. Therefore, we undertook a systematic review and meta‐analyses of the studies focusing on BCLC‐factors matching. Methods We systematically searched PubMed, the Cochrane database, EMBASE, and Web of Science to identify studies comparing RFA and SBRT using propensity scores. The hazard ratios (HRs) of overall survival (OS) and LC from BCLC‐factor‐matched and ‐unmatched PSMS were pooled. Heterogeneity between the data from these studies was assessed. Results Three BCLC‐factor‐matched studies were identified. Stereotactic body radiotherapy led to comparable OS (HR, 0.89; 95% CI, 0.74–1.08; p = 0.24; I 2 = 0%; p for heterogeneity, 0.56) and significantly better LC (HR, 0.39; 95% CI, 0.30–0.51; p < 0.001; I 2 = 0%; p for heterogeneity, 0.67). We also identified three additional BCLC‐factor‐unmatched studies (HR of OS, 1.41; 95% CI, 1.21–1.65; p < 0.0001; I 2 = 0%; p for heterogeneity, 0.63). However, considerable heterogeneity was observed for HR of OS between BCLC‐factor‐matched and ‐unmatched studies ( I 2 = 92.6%; p for heterogeneity, 0.0002). Conclusions When BCLC‐factors were properly adjusted, the results of the meta‐analysis revealed equivalent OS and better LC for SBRT compared with RFA. Stereotactic body radiotherapy could be an alternative treatment option for HCC.
The target volume for postoperative breast irradiation is the remaining breast tissue, and the axillary region is not an intentional target volume.Between 2001 and 2009, eligible women with pT1-2cN0/pN0(sn) breast cancer underwent breast-conserving therapy without axillary dissection. Treatment outcomes between 2 radiotherapy planning groups, high tangent fields with 2-dimensional (2-D) simulation-based planning and 3-dimensional (3-D) computed tomography-based planning with a field-in-field technique, were compared. The correlating factors for axillary failure were also calculated.In total, 678 patients were eligible. As of May 2009, the median follow-up times for the 2-D (n = 346) and 3-D (n = 332) groups were 94 and 52 months, respectively. Patient characteristics were balanced, except for a younger population in the 2-D group and more lymphovascular invasion in the 3-D group. On multivariate analysis, 2-D planning was the only risk factor for axillary failure. In the 2-D and 3-D groups, the 5-year cumulative incidences of axillary failure were 8 (3.1%) and 1 (0.3%) (log-rank p = 0.009), respectively. The respective 5-year overall survival rates were 97.4 and 98.4% (p = 0.4).High tangent irradiation with 3-D planning improved axillary control compared to that with 2-D planning, suggesting that optimizing axillary dose distribution may impact outcomes.Das Zielvolumen für die postoperative Bestrahlung der Mamma ist das restliche Brustgewebe. Die axilläre Region stellt dagegen kein beabsichtigtes Zielvolumen dar.Zwischen 2001 und 2009 wurde bei entsprechend geeigneten Frauen mit einem pT1–2cN0/pN0(sn)-Mammakarzinom eine brusterhaltende Therapie ohne Axilladissektion durchgeführt. Das Outcome zweier Gruppen mit unterschiedlicher Bestrahlungsplanung – hohe Tangenten mit zweidimensionaler (2-D), simulationsbasierter Planung bzw. dreidimensionale (3-D), computertomographie-basierte Planung mit «Field-in-Field»-Technik – wurden verglichen. Desweiteren wurden korrelierende Risikofaktoren für ein axilläres Rezidiv kalkuliert.Insgesamt waren 678 Patientinnen für die Studie geeignet. Im Mai 2009 war das mediane Follow-Up in der 2-D-Gruppe (n = 346) bzw. der 3-D-Gruppe (n = 332) 94 bzw. 52 Monate. Die Patientenmerkmale waren bis auf ein jüngeres Alter in der 2-D-Gruppe und häufigere lym-phovaskulärer Invasion in der 3-D-Gruppe ausgewogen. In der Multivariatanalyse war die 2-D-Planung der einzige Risikofaktor für ein axilläres Rezidiv. Die kumulative 5-Jahres-Inzidenz eines Axillarezidivs war 8 (3,1%) bzw. 1 (0,3%) in der 2-D- bzw. 3-D-Gruppe (Log-Rank p = 0,009). Die 5-Jahres-Gesamtüberlebensrate war 97,4 bzw. 98,4% (p = 0,4).Durch die Bestrahlung mit hohen Tangenten und 3-D-Planung konnte die Axilla besser unter Kontrolle gebracht werden als mit 2-D-Planung, was andeutet, dass eine optimierte Dosisverteilung in der Axilla positive Auswirkungen auf das Outcome hat.
