External Beam Radiation Therapy and Immunotherapy in the Management of Hepatobiliary Malignancies: A Meta-analysis of Treatment Response Rates
Abstract
Purpose: To evaluate, in a meta-analysis, the efficacy of external beam radiation therapy (EBRT) with immunotherapy (IO) in hepatobiliary malignancies, including hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA), and identify factors associated with improved treatment response.
Methods and materials: Observational studies or clinical trials reporting objective response rates (ORRs) and disease control rates (DCRs) for patients with advanced or unresectable HCC or CCA treated with EBRT plus at least one IO agent were included. PubMed, Web of Science, and Cochrane were searched through February 2025. Pooled ORR and DCR were calculated using random-effects models with inverse variance weighting and double-arcsine transformation. Subgroup analyses were performed by study design (retrospective studies vs clinical trials), radiation target (primary vs primary + metastasis), radiation dose (high vs low biologically effective dose [BED]), and IO regimen. Meta-regression was performed to study the associated between BED and response rates.
Results: Twenty-two HCC studies (971 patients) and 3 CCA studies (136 patients) met inclusion criteria. Pooled ORR was 58% (95% CI, 50%-65%) and DCR was 79% (95% CI, 71%-85%) for HCC, with no difference between study designs. Radiation target, and dose were not associated with improved response in subgroup analysis. However, meta-regression showed an improved ORR for higher BED (1.14% increase per Gy) on clinical trials (P = .021). No…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 971 participants or records.
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