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

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An Erratum to this article was published on 25 May 2017

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.

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Notes

  1. http://www.cancer.org/acs/groups/content/@editorial/documents/document/acspc-044552.pdf.

  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+radioembolization&rank=1.

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Authors and Affiliations

  1. Division of Surgical Oncology at Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA

    Laila Lobo, Danny Yakoub, Omar Picado, Caroline Ripat, Fiorella Pendola, Rishika Sharma & Rana ElTawil

  2. Department of Biostatistics and Bioinformatics, Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA

    Deukwoo Kwon

  3. Department of Radiology, Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA

    Shree Venkat

  4. Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA

    Loraine Portelance & Raphael Yechieli

  5. Department of Radiation Oncology, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, 1475 NW 12th Ave, Suite 1500, Miami, FL, 33136, USA

    Raphael Yechieli

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  1. Laila Lobo
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with human participants or animals performed by any of the authors.

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An erratum to this article is available at http://dx.doi.org/10.1007/s00270-017-1693-2.

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Lobo, L., Yakoub, D., Picado, O. et al. Unresectable Hepatocellular Carcinoma: Radioembolization Versus Chemoembolization: A Systematic Review and Meta-analysis. Cardiovasc Intervent Radiol 39, 1580–1588 (2016). https://doi.org/10.1007/s00270-016-1426-y

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