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

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.

Efficacy of Regorafenib in Hepatocellular Carcinoma Patients: A Systematic Review and Meta-Analysis

“…Of note, all of the included studies recruited patients who progressed on sorafenib, therefore the eventual role of regorafenib in the first-line setting is unknown. Further studies are needed in order to evaluate the competitive role of regorafenib with other systemic agents [24], in particular sorafenib, and with transarterial radioembolization in intermediate/advanced HCC patients with portal vein invasion [25][26][27].…”

Statin Use Decreases the Incidence of Hepatocellular Carcinoma: An Updated Meta-Analysis

“…Hepatocellular carcinoma (HCC) is the fifth most commonly occurring type of cancer and the leading cause of mortality in cirrhotic patients [1]. Despite the recent improvement in diagnosis and screening programs in cirrhotics, a great number of patients are still diagnosed in the advanced stage, thus being unsuitable to curative treatments, such as surgery, orthotopic liver transplantation, or radiofrequency ablation [2][3][4]. Therefore, the identification of prognostic factors for HCC occurrence is of paramount importance in order to decrease the burden of this disease, in particular in high-risk populations, such as cirrhotic or chronic hepatitis B virus (HBV) patients.…”

Real-World Data for the Evaluation of Transarterial Radioembolization versus Sorafenib in Hepatocellular Carcinoma: A Cost-Effectiveness Analysis

“…The evidence that supports the use of TARE in HCC treatment is mainly based on retrospective or prospective observational studies [12][13][14][15][16], and no cost-effectiveness analyses have been performed comparing the use of TARE with that of sorafenib for the treatment of patients with HCC. Two randomized controlled trials (RCTs) comparing TARE with sorafenib are ongoing at present (YES-P: NCT01887717; SARAH: NCT01482442).…”