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Meta-Analysis
. 2016 Nov 1;7(44):72343-72355.
doi: 10.18632/oncotarget.11644.

Trans-arterial radioembolization in intermediate-advanced hepatocellular carcinoma: systematic review and meta-analyses

Carla Rognoni  1 , Oriana Ciani  1   2 , Silvia Sommariva  1 , Antonio Facciorusso  3 , Rosanna Tarricone  1   4 , Sherrie Bhoori  3 , Vincenzo Mazzaferro  3
Affiliations
Meta-Analysis

Trans-arterial radioembolization in intermediate-advanced hepatocellular carcinoma: systematic review and meta-analyses

Carla Rognoni et al. Oncotarget. .

Abstract

Trans-arterial radioembolization (TARE) is a recognized, although not explicitly recommended, experimental therapy for unresectable hepatocellular carcinoma (HCC).A systematic literature review was performed to identify published studies on the use of TARE in intermediate and advanced stages HCC exploring the efficacy and safety of this innovative treatment.Twenty-one studies reporting data on overall survival (OS) and time to progression (TTP), were included in a meta-analysis. The pooled post-TARE OS was 63% (95% CI: 56-70%) and 27% (95% CI: 21-33%) at 1- and 3-years respectively in intermediate stage HCC, whereas OS was 37% (95% CI: 26-50%) and 13% (95% CI: 9-18%) at the same time intervals in patients with sufficient liver function (Child-Pugh A-B7) but with an advanced HCC because of the presence of portal vein thrombosis. When an intermediate and advanced case-mix was considered, OS was 58% (95% CI: 48-67%) and 17% (95% CI: 12-23%) at 1- and 3-years respectively. As for TTP, only four studies reported data: the observed progression probability was 56% (95% CI: 41-70%) and 73% (95% CI: 56-87%) at 1 and 2 years respectively. The safety analysis, focused on the risk of liver decompensation after TARE, revealed a great variability, from 0-1% to more than 36% events, influenced by the number of procedures, patient Child-Pugh stage and treatment duration.Evidence supporting the use of radioembolization in HCC is mainly based on retrospective and prospective cohort studies. Based on this evidence, until the results of the ongoing randomized trials become available, radioembolization appears to be a viable treatment option for intermediate-advanced stage HCC.

Keywords: advanced stage; hepatocellular carcinoma; intermediate stage; meta-analysis; trans-arterial radioembolization.

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Conflict of interest statement

CONFLICTS OF INTEREST

All the authors have no conflicts of interest to declare. SB and VM received lectures and educational fees from Nordion Inc, BTG Plc and Bayer Pharma. VM is partially supported by AIRC (Italian Association for Cancer Research) and INT-Milan institutional grant (5×1000 grant).

No interferences occurred in carrying out the research project and in writing the manuscript whose content is the sole responsibility of the authors.

Figures

Figure 1
Figure 1. Study flow chart
Figure 2
Figure 2
A. Overall survival rates at different follow-up times in intermediate-advanced HCC patients without PVT receiving TARE. B. Overall survival rates at different follow-up times in advanced HCC patients with PVT receiving TARE
Figure 2
Figure 2
A. Overall survival rates at different follow-up times in intermediate-advanced HCC patients without PVT receiving TARE. B. Overall survival rates at different follow-up times in advanced HCC patients with PVT receiving TARE
Figure 3
Figure 3
A. Probability of tumor progression at different follow-up times in intermediate-advanced HCC patients without PVT receiving TARE. B. Probability of tumor progression at different follow-up times in advanced HCC patients with PVT receiving TARE.
Figure 3
Figure 3
A. Probability of tumor progression at different follow-up times in intermediate-advanced HCC patients without PVT receiving TARE. B. Probability of tumor progression at different follow-up times in advanced HCC patients with PVT receiving TARE.
See this image and copyright information in PMC

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