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CardioVascular and Interventional Radiology

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01-02-2007 | REVIEW

Transarterial Therapy for Hepatocellular Carcinoma: Which Technique Is More Effective? A Systematic Review of Cohort and Randomized Studies

Authors: Laura Marelli, Rosa Stigliano, Christos Triantos, Marco Senzolo, Evangelos Cholongitas, Neil Davies, Jonathan Tibballs, Tim Meyer, David W. Patch, Andrew K. Burroughs

Published in: CardioVascular and Interventional Radiology | Issue 1/2007

Abstract

Background

Chemoembolization (TACE) improves survival in cirrhotic patients with hepatocellular carcinoma (HCC). The optimal schedule, or whether embolization (TAE) alone gives the same survival advantage, is not known.

Purpose

To evaluate whether specific patient characteristics and/or radiological transarterial techniques result in better outcomes.

Method

A PubMed search was carried out for cohort and randomized trials (n = 175) testing transarterial therapies; meta-analysis was performed where appropriate.

Results

Anticancer drugs were used as sole agent in 75% of cases (double 15% and triple 6%): doxorubicin (36%), cisplatin (31%), epirubicin (12%), mitoxantrone (8%), mitomycin (8%), and SMANCS (5%). Embolizing agents used were: gelatin sponge particles (71%), polyvinyl alcohol (PVA) particles (8%), degradable starch microspheres (DSM) (4%), and embospheres (4%). Sessions per patient were 2.5 ± 1.5 (interval: 2 months). Objective response was 40 ± 20%; survival rates at 1, 2, 3, and 5 years were: 62 ± 20%, 42 ± 17%, 30 ± 15%, and 19 ± 16%, respectively, and survival time was 18 ± 9.5 months. The post-TACE complications were: acute liver failure, 7.5% (range 0–49%); acute renal failure, 1.8% (0–13%); encephalopathy, 1.8% (0–16%); ascites, 8.3% (0–52%); upper gastrointestinal bleeding; 3% (0–22%); and hepatic or splenic abscess, 1.3% (0–2.5%). Treatment-related mortality was 2.4% (0–9.5%), mainly due to acute liver failure. Our meta-analysis of nine randomized controlled trials (RCTs) confirmed that TACE improves survival; but a meta-analysis of TACE versus TAE alone (3 RCTs, 412 patients) demonstrated no survival difference.

Conclusions

No chemotherapeutic agent appears better than any other. There is no evidence for benefit with lipiodol. Gelatin sponge is the most used embolic agent, but PVA particles may be better. TAE appears as effective as TACE. New strategies to reduce the risk of post-TACE complications are required.

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Title: Transarterial Therapy for Hepatocellular Carcinoma: Which Technique Is More Effective? A Systematic Review of Cohort and Randomized Studies
Authors: Laura Marelli
Rosa Stigliano
Christos Triantos
Marco Senzolo
Evangelos Cholongitas
Neil Davies
Jonathan Tibballs
Tim Meyer
David W. Patch
Andrew K. Burroughs
Publication date: 01-02-2007
Publisher: Springer-Verlag
Published in: CardioVascular and Interventional Radiology / Issue 1/2007
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-006-0062-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Transarterial Therapy for Hepatocellular Carcinoma: Which Technique Is More Effective? A Systematic Review of Cohort and Randomized Studies

Abstract

Background

Purpose

Method

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Purpose

Method

Results

Conclusions

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