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Meta-Analysis
. 2015 Oct 8;10(10):e0139940.
doi: 10.1371/journal.pone.0139940. eCollection 2015.

Comparative Effectiveness of Hepatic Artery Based Therapies for Unresectable Colorectal Liver Metastases: A Meta-Analysis

Anthony J Zacharias  1 , Thejus T Jayakrishnan  1 , Rahul Rajeev  1 , William S Rilling  2 , James P Thomas  3 , Ben George  3 , Fabian M Johnston  1 , T Clark Gamblin  1 , Kiran K Turaga  1
Affiliations
Meta-Analysis

Comparative Effectiveness of Hepatic Artery Based Therapies for Unresectable Colorectal Liver Metastases: A Meta-Analysis

Anthony J Zacharias et al. PLoS One. .

Abstract

Background: Patients with unresectable Colorectal Liver Metastases (CRLM) are increasingly being managed using Hepatic Artery Based Therapies (HAT), including Hepatic Arterial Infusion (HAI), Radioembolization (RE), and Transcatheter Arterial Chemoembolization (TACE). Limited data is available on the comparative effectiveness of these options. We hypothesized that outcomes in terms of survival and toxicity were equivalent across the three strategies.

Methods: A meta-analysis was performed using a prospectively registered search strategy at PROSPERO (CRD42013003861) that utilized studies from PubMed (2003-2013). Primary outcome was median overall survival (OS). Secondary outcomes were treatment toxicity, tumor response, and conversion of the tumor to resectable. Additional covariates included prior or concurrent systemic therapy.

Results: Of 491 studies screened, 90 were selected for analyses-52 (n = 3,000 patients) HAI, 24 (n = 1,268) RE, 14 (n = 1,038) TACE. The median OS (95% CI) for patients receiving HAT in the first-line were RE 29.4 vs. HAI 21.4 vs. TACE 15.2 months (p = 0.97, 0.69 respectively). For patients failing at least one line of prior systemic therapy, the survival outcomes were TACE 21.3 (20.6-22.4) months vs. HAI 13.2 (12.2-14.2) months vs. RE 10.7 (9.5-12.0). Grade 3-4 toxicity for HAT alone was 40% in the HAI group, 19% in the RE group, and 18% in the TACE groups, which was increased with the addition of systemic chemotherapy. Level 1 evidence was available in 5 studies for HAI, 2 studies for RE and 1 for TACE.

Conclusion: HAI, RE, and TACE are equally effective in patients with unresectable CRLM with marginal differences in survival.

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Conflict of interest statement

Competing Interests: The authors declare the following interests: William Rilling: PI for MDS Nordion Trial, PI for DEBIRI trial, Consultant SIRTEX. T. Clark Gamblin: Speakers bureau Therasphere (prior to 2012). There are no patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. PRISMA Flow Chart Depicting Stages of Article Selection [21].
HAT hepatic artery based therapy.
Fig 2
Fig 2. Distribution of Toxicity (Events per 100 Patients) Reported Across HAI, RE and TACE.
HAI hepatic arterial infusion; RE radioembolization; TACE transcatheter chemoembolization; HAT hepatic artery based therapy; Sys concurrent systemic chemotherapy.
See this image and copyright information in PMC

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