Unresectable Hepatocellular Carcinoma

Radioembolization Versus Chemoembolization: A Systematic Review and Meta-analysis

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

Research output: Contribution to journalArticle

21 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1580-1588
Number of pages9
JournalCardiovascular and Interventional Radiology
Volume39
Issue number11
DOIs
StatePublished - Nov 1 2016
Externally publishedYes

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Meta-Analysis
Hepatocellular Carcinoma
Confidence Intervals
Therapeutics
Survival Rate
Nausea
Patient Selection
Vomiting
Observational Studies
Fatigue
Length of Stay
Epidemiology
Fever
Outpatients
Pain
Survival
Incidence

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Unresectable Hepatocellular Carcinoma : Radioembolization Versus Chemoembolization: A Systematic Review and Meta-analysis. / Lobo, Laila; Yakoub, Danny; Picado, Omar; Ripat, Caroline; Pendola, Fiorella; Sharma, Rishika; ElTawil, Rana; Kwon, Deukwoo; Venkat, Shree; Portelance, Loraine; Yechieli, Raphael.

In: Cardiovascular and Interventional Radiology, Vol. 39, No. 11, 01.11.2016, p. 1580-1588.

Research output: Contribution to journalArticle

Lobo, L, Yakoub, D, Picado, O, Ripat, C, Pendola, F, Sharma, R, ElTawil, R, Kwon, D, Venkat, S, Portelance, L & Yechieli, R 2016, 'Unresectable Hepatocellular Carcinoma: Radioembolization Versus Chemoembolization: A Systematic Review and Meta-analysis', Cardiovascular and Interventional Radiology, vol. 39, no. 11, pp. 1580-1588. https://doi.org/10.1007/s00270-016-1426-y
Lobo, Laila ; Yakoub, Danny ; Picado, Omar ; Ripat, Caroline ; Pendola, Fiorella ; Sharma, Rishika ; ElTawil, Rana ; Kwon, Deukwoo ; Venkat, Shree ; Portelance, Loraine ; Yechieli, Raphael. / Unresectable Hepatocellular Carcinoma : Radioembolization Versus Chemoembolization: A Systematic Review and Meta-analysis. In: Cardiovascular and Interventional Radiology. 2016 ; Vol. 39, No. 11. pp. 1580-1588.
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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.",
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AU - Picado, Omar

AU - Ripat, Caroline

AU - Pendola, Fiorella

AU - Sharma, Rishika

AU - ElTawil, Rana

AU - Kwon, Deukwoo

AU - Venkat, Shree

AU - Portelance, Loraine

AU - Yechieli, Raphael

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