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

Carla Rognoni,Oriana Ciani,Sherrie Bhoori,Vincenzo Mazzaferro,Rosanna Tarricone,Silvia Sommariva,Antonio Facciorusso

doi:10.18632/oncotarget.11644

Carla Rognoni, Oriana Ciani + Show 5 more

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https://doi.org/10.18632/oncotarget.11644

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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.

Highlights

Hepatocellular carcinoma represents the third most common cause of cancer death, causing nearly 746,000 deaths per year in the world [1, 2]
In the light of the increasing use of this innovative therapy in clinical practice, this study aims to systematically review the available evidence for the clinical efficacy and safety of Trans-arterial radioembolization (TARE) in patients with intermediate-advanced stages hepatocellular carcinoma (HCC)
A summary of the critical appraisal of TARE studies is reported in Supplementary Table 2

Summary

Introduction

Hepatocellular carcinoma represents the third most common cause of cancer death, causing nearly 746,000 deaths per year in the world [1, 2]. Prognosis of patients with HCC is poor, with a ratio of mortality to incidence of 0.95 [2]. HCC represents a major global health problem, considering that its incidence increases progressively with aging of population [4]. The Child-Pugh score is used to assess the prognosis of chronic liver disease, mainly cirrhosis [5]. Patients are classified according to different expected survivals from A to C (two year survival: A 85%, B 57%, C 35%) based on five clinical measures of liver disease (total bilirubin, serum albumin, prothrombin time, ascites, hepatic encephalopathy). The American and European Societies for the Study of the Liver endorse the Barcelona Clinic www.impactjournals.com/oncotarget

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