Trans-arterial radioembolization in intermediate-advanced hepatocellular carcinoma: systematic review and meta-analyses
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Carla Rognoni1, Oriana Ciani1,2, Silvia Sommariva1, Antonio Facciorusso3, Rosanna Tarricone1,4, Sherrie Bhoori3 and Vincenzo Mazzaferro3
1 Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy
2 Evidence Synthesis and Modelling for Health Improvement (ESMI), University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, UK
3 Department of Surgery, Liver Surgery, Transplantation and Gastroenterology, Istituto Nazionale Tumori Fondazione IRCCS, National Cancer Institute of Milan, and University of Milan, Milan, Italy
4 Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
Carla Rognoni, email:
Keywords: hepatocellular carcinoma, intermediate stage, advanced stage, trans-arterial radioembolization, meta-analysis
Received: April 16, 2016 Accepted: July 10, 2016 Published: August 26, 2016
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.
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