Stereotactic body radiation therapy versus radiofrequency ablation in patients with small hepatocellular carcinoma:a systematic review and meta-analysis

Background:This study aimed to compare the clinical outcomes and toxicity between small hepatocellular carcinoma(HCC)patients treated with stereotactic body radiation therapy(SBRT)and those treated with radiofrequency ablation(RFA).Methods:We searched databases for relevant clinical studies.The primary outcomes of interest were overall survival(OS)at 1 and 2 years,freedom from local progression(FFLP)rate at 2 years,and complications.Results:Five cohorts from 5 retrospective studies and 4,814 patients with HCC were included.Pooled OS at 2 years was significantly lower for SBRT than for RFA[odds ratio(OR):0.63;95%confidence interval(CI):0.51-0.79;P<0.0001],but the pooled FFLP rate at 2 years was higher for SBRT than for RFA(OR:1.66;95%CI:1.05-2.61;P=0.03).In addition,there was no significant difference in the local and liver toxicities of the two treatments.The contradictory conclusion between the OS and FFLP outcome may be attributed to the difference in radiological dose and location,but there were no uniform criteria to illustrate the radiological dose and location in the included studies.Conclusions:SBRT had a higher local control ratio but poorer prognosis than RFA in patients with small HCC.The local toxicity was comparable in both treatments.Further trials should be designed with uniform standards for SBRT and RFA treatments.

Potential of extracellular vesicles and exosomes as diagnostic markers for cholangiocarcinoma

Cholangiocarcinoma(CCA),a malignant carcinoma originating from biliary epithelium,is the second largest primary liver malignancy,accounting for 10-15%of hepatobiliary malignancies.Macroscopically,CCA is a fatal malignancy,with a 5-year survival rate of less than 10%(1).The lack of typical symptoms and signs makes early CCA difficult to identify and diagnose by early health screening.The diagnosis of CCA mainly relies on radiography,tumor biomarkers,invasive diagnosis,as well as pathological examination,which results in the majority of patients being detected in the middle and late stages,and only about one-third of CCA patients have access to treatment(1).