Yttrium-90 transarterial radioembolization versus conventional transarterial chemoembolization for patients with hepatocellular carcinoma: a systematic review and meta-analysis

Abstract

Objective:To compare the effects and safety of conventional transarterial chemoembolization (cTACE) and yttrium-90 transarterial radioembolization [TARE (90Y)] for hepatocellular carcinoma (HCC)Methods:Nine high-quality observational studies, one low bias-risk randomized controlled trial (RCT), and one moderate bias-risk RCT included 1,652 patients [cTACE, 1,124; TARE (90Y), 528], from whom data were extracted for this systematic review and meta-analysis.Results:The extracted study outcomes included 1-year and 2-year overall survival (OS) rates, objective responses (ORs), and serious adverse events (AEs). 1-year OS rates: OR = 0.939, 95 % CI: 0.705-1.251, P = 0.66. 2-year OS rates: overall pooled OR = 0.641, 95% CI: 0.382-1.075, P = 0.092; observational study subgroup OR = 0.575, 95% CI: 0.336-0.984, P = 0.043; RCT subgroup OR* = 0.641, 95% CI: 0.382-1.075, P = 0.346. OR: overall pooled OR = 0.781, 95% CI: 0.454-1.343, P = 0.371; mRECIST subgroup OR = 0.584, 95 % CI: 0.349-0.976, P = 0.040; WHO subgroup OR = 1.065; 95% CI: 0.500-2.268, P = 0.870. Serious AEs: overall pooled RR = 1.477, 95% CI: 0.864-2.526, P = 0.154; RCT subgroup RR = 0.680, 95% CI: 0.325-1.423, P = 0.306; observational study subgroup RR = 1.925; 95 % CI: 0.978-3.788, P = 0.058. Conclusions:TARE (90Y) increased 2-year OS rates in the observational subgroup and resulted in better OR rates, according to mRECIST criteria, in comparison with cTACE. Furthermore, a lower risk of AEs was observed for TARE (90Y) than for cTACE.

Effect of Yttrium-90 transarterial radioembolization in patients with non-surgical hepatocellular carcinoma: A systematic review and meta-analysis

“…Differing from other systematic reviews [ 8 , 31 – 33 ], our work examined both progression-free survival and time to progression, which are outcomes used as primary endpoints in some randomized controlled trials in HCC. Our results suggesting that the use of glass microsphere Y90-TARE may possibly be associated with longer time to progression as compared to standard of care treatment differ from prior meta-analyses [ 8 , 9 , 31 – 36 ]. Previous studies comparing the resin and glass microsphere to deliver the treatment showed conflicting results [ 37 , 38 ].…”

“…Our work is however more exhaustive and not limited to one specific comparator in the context of absence of a unique standard of care. Previous systematic reviews suggesting a survival benefit with the use of Y90-TARE [ 9 , 35 , 36 ] had major limitations in their design including the consideration of non-randomised controlled studies. Differing from other systematic reviews [ 8 , 31 – 33 ], our work examined both progression-free survival and time to progression, which are outcomes used as primary endpoints in some randomized controlled trials in HCC.…”

Current State of Liver-Directed Therapies and Combinatory Approaches with Systemic Therapy in Hepatocellular Carcinoma (HCC)

“…A meta-analysis including nine observational studies and 2 randomized trials ( n = 1652) found an association of Y-90 with higher OS, response rates and lower adverse event rates when compared to conventional TACE. Symptoms of post-embolization syndrome are less expected [50]. The first randomized phase II, with ( n = 28) Child–Pugh A patients identified similar disease control rates between the treatment strategies [51].…”

Transarterial strategies for the treatment of unresectable hepatocellular carcinoma: A systematic review

“…No significant differences in the incidence of nausea and vomiting and fever have been observed, which is consistent with our study findings. To easily understand the research status of this subject, we summarized the meta studies in S6 Table [3,[45][46][47][48][49][50][51][52].…”