{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T13:58:07Z","timestamp":1793973487152,"version":"4.8.0"},"reference-count":35,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T00:00:00Z","timestamp":1738195200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>External\u2010beam radiation (EBRT) is a noninvasive therapeutic alternative to transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). The objective of this study was to conduct a systematic review and meta\u2010analysis of prospective randomized clinical trials to assess the clinical efficacy of EBRT versus TACE for HCC as either a definitive monotherapy or as a bridge to transplantation\/surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A systematic review and meta\u2010analysis were performed to include prospective randomized trials comparing EBRT versus TACE. Data was analyzed with random and fixed\u2010effects models. The inconsistency index (I<jats:sup>2<\/jats:sup>) was chosen to assess heterogeneity. Three publications were included with a total of 142 patients. Outcomes included local control (LC), overall survival (OS), progression\u2010free survival (PFS), and occurrences of grade \u22653 toxicity. Comparisons are reported as hazard ratios (HRs) or risk ratios (RRs) with 95% confidence intervals (CIs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were three randomized trials that met inclusion criteria. The EBRT was delivered in three to 15 fractions with a total dose between 30 and 75 gray(Gy). EBRT was associated with significantly improved LC (HR, 0.16; 95% CI, 0.08\u20130.34; I<jats:sup>2<\/jats:sup>\u00a0=\u00a00%) and PFS (HR, 0.37; 95% CI, 0.23\u20130.60; I<jats:sup>2<\/jats:sup>, 0%) compared with TACE. There was no significant difference between EBRT and TACE in OS (RR, 0.79; 95% CI, 0.51\u20131.22; I<jats:sup>2<\/jats:sup>\u00a0=\u00a00%) or grade \u22653 toxicity (RR, 0.86; 95% CI, 0.31\u20132.37; I<jats:sup>2<\/jats:sup>\u00a0=\u00a057%). None of the analyses had statistically significant heterogeneity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Compared with TACE, EBRT yields superior LC and PFS without providing a survival benefit in early and intermediate stage HCC. Additional larger prospective randomized controlled trials should be conducted to further investigate differences in clinical outcomes amongst patients with more advanced disease.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.35720","type":"journal-article","created":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T06:02:40Z","timestamp":1738216960000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Meta\u2010analysis of randomized controlled trials of external\u2010beam radiation versus transarterial chemoembolization for hepatocellular carcinoma"],"prefix":"10.1002","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-3347-6515","authenticated-orcid":false,"given":"Ryan A.","family":"Kuehnle","sequence":"first","affiliation":[{"name":"Long School of Medicine University of Texas Health Science Center at San Antonio  San Antonio Texas 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