Effectiveness of Radiotherapy for Hepatocellular Carcinoma with Lymph Node Metastasis: A Meta-Analysis

Lymph node metastasis (LNM) of hepatocellular carcinoma (HCC) carries a poor prognosis; however, no standard treatment has been established. Radiotherapy (RT) has demonstrated favorable tumor response, with the advantage of being less affected by anatomical hindrances. Databases were searched up to April 2024. The inclusion criteria were: (1) ≥5 patients with HCC LNM, (2) studies that performed external RT, and (3) reporting survival or response rate (RR). The main effect measures are pooled 1- and 2-year overall survival (OS) rates, response rate (RR) and grade ≥3 complications. Twelve studies involving 825 patients were included. The pooled 1-year OS rate and 2-year OS rate were 49.3% (95% confidence interval [CI]: 39.2%-59.4%) and 24.5% (95% CI: 17.0%-34.0%), respectively. The median OS ranged from 5.8 to 29.7 months, with a median value of 9.7 months. In one study, 14.7% of patients were prescribed an immunoagent. In other studies, some patients received sorafenib, but no specific systemic therapy was performed for the majority. The pooled RR was 75.1% (95% CI: 66.9%-81.8%). The pooled RR of high dose and low dose groups was 83.8% (95% CI: 76.3-89.3) vs. 55.6% (95% CI: 44.4-66.3), respectively (p<0.001). The pooled rate of grade ≥3 gastrointestinal toxicity was 3.7% (95% CI: 2.1%-6.6%). RT is an effective and feasible palliative option for HCC LNM. Further researches of combined treatment with novel systemic agents are necessary.