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CardioVascular and Interventional Radiology
Published in: CardioVascular and Interventional Radiology 11/2016

01-11-2016 | SCIENTIFIC PAPER, FULL

Unresectable Hepatocellular Carcinoma: Radioembolization Versus Chemoembolization: A Systematic Review and Meta-analysis

Authors: Laila Lobo, Danny Yakoub, Omar Picado, Caroline Ripat, Fiorella Pendola, Rishika Sharma, Rana ElTawil, Deukwoo Kwon, Shree Venkat, Loraine Portelance, Raphael Yechieli

Published in: CardioVascular and Interventional Radiology | Issue 11/2016

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Abstract

Background

Transarterial radioembolization (TARE) has emerged as a newer regional therapy to transarterial chemoembolization (TACE) for treatment of unresectable hepatocellular carcinoma (HCC). The aim of this study is to compare clinical outcomes of both the techniques.

Methods

Online search for studies comparing TARE to TACE from 2005 to present was performed. Primary outcome was overall survival rate for up to 4 years. Secondary outcomes included post-treatment complications and treatment response. Quality of included studies was evaluated by STrengthening the Reporting of OBservational studies in Epidemiology criteria. Relative risk (RR) and 95 % confidence intervals (CI) were calculated from pooled data.

Results

The search strategy yielded 172 studies, five met selection criteria and included 553 patients with unresectable HCC, 284 underwent TACE and 269 underwent TARE. Median ages were 63 and 64 years for TACE and TARE, respectively. Meta-analysis showed no statistically significant difference in survival for up to 4 years between the two groups (HR = 1.06; 95 % CI 0.81–1.46, p = 0.567). TACE required at least one day of hospital stay compared to TARE which was mostly an outpatient procedure. TACE had more post-treatment pain than TARE (RR = 0.51, 95 % CI 0.36–0.72, p < 0.01), but less subjective fatigue (RR = 1.68, 95 % CI 1.08–2.62, p < 0.01). There was no difference between the two groups in the incidence of post-treatment nausea, vomiting, fever, or other complications. In addition, there was no difference in partial or complete response rates between the two groups.

Conclusion

TARE appears to be a safe alternative treatment to TACE with comparable complication profile and survival rates. Larger prospective randomized trials, focusing on patient-reported outcomes and cost–benefit analysis are required to consolidate these results.
Appendix
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Footnotes
2
Vilgrain V, Abdel-Rehim M, et al. SARAH Trial Group. Radioembolization with yttrium-90 microspheres versus sorafenib for treatment of advanced hepatocellular carcinoma (SARAH): study protocol for a randomized controlled trial. Trials. 2014 Dec 3;15:474.
 
3
A Phase III Clinical Trial of Intra-arterial TheraSphere® in the Treatment of Patients With Unresectable Hepatocellular Carcinoma (HCC). https://​clinicaltrials.​gov/​ct2/​show/​NCT01556490?​term=​stop+hcc&​rank=​1.
 
4
An Investigator Initiated Multicenter Prospective Randomized Study of Chemoembolization Versus Radioembolization for the Treatment of Hepatocellular Carcinoma. https://​clinicaltrials.​gov/​ct2/​show/​NCT00956930?​term=​premiere+radioem​bolization&​rank=​1.
 
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Metadata
Title
Unresectable Hepatocellular Carcinoma: Radioembolization Versus Chemoembolization: A Systematic Review and Meta-analysis
Authors
Laila Lobo
Danny Yakoub
Omar Picado
Caroline Ripat
Fiorella Pendola
Rishika Sharma
Rana ElTawil
Deukwoo Kwon
Shree Venkat
Loraine Portelance
Raphael Yechieli
Publication date
01-11-2016
Publisher
Springer US
Published in
CardioVascular and Interventional Radiology / Issue 11/2016
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-016-1426-y

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