Lipiodol transarterial chemoembolization for hepatocellular carcinoma: A systematic review of efficacy and safety data

By Riccardo Lencioni, T. de Baère, Michael C. Soulen, W. Rilling, J. Geschwind. Hepatology, 2016

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Transarterial chemoembolization (TACE) using lipiodol‐based regimens, including the administration of an anticancer‐in‐oil emulsion followed by embolic agents, is widely used in the treatment of hepatocellular carcinoma (HCC). This approach has been supported by meta‐analyses of randomized, controlled trials (RCTs) performed more than a decade ago. We performed a systematic review to understand current efficacy and safety data of lipiodol TACE in treatment of HCC. A search of the literature published between January 1, 1980 and June 30, 2013 was performed using MEDLINE and EMBASE databases. All potentially relevant publications were reviewed and articles were selected based on predefined inclusion and exclusion criteria. Of a total of 1,564 articles reviewed, 101 articles, including a total of 10,108 patients treated with lipiodol TACE, were selected for the efficacy analysis. Objective response rate was 52.5% (95% confidence interval [CI]: 43.6‐61.5). Overall survival (OS) was 70.3% at 1 year, 51.8% at 2 years, 40.4% at 3 years, and 32.4% at 5 years. Median OS was 19.4 months (95% CI: 16.2‐22.6). A total of 217 articles presenting precise description on numbers of adverse events (AEs) were selected for the safety review: In these studies, a total of 21,461 AEs were reported in 15,351 patients. Liver enzyme abnormalities were the most commonly observed AE, followed by the symptoms associated with postembolization syndrome. Overall mortality rate was 0.6% and the most common cause of death was related to acute liver insufficiency. Conclusions: In a systematic literature review, survival figures of HCC patients undergoing lipiodol TACE appear to be in line with those reported in previous RCTs, and no new or unexpected safety concerns were identified. (Hepatology 2016;64:106–116)

Subfields: Hepatology, Pulmonary and Respiratory Medicine, Surgery

View Paper: https://www.semanticscholar.org/paper/4ffcc203c02ed0bd811a5ecf9d333127fdc763fa

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Citations in the corpus

AASLD Practice Guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma (2023, positive): “[285] Patients who achieve objective response by modified response evaluation criteria in solid tumors (mRECIST) have prolonged survival compared with those without response (HR, 0.39; 95% CI, 0.26 – 0.619).”
Global trends in hepatocellular carcinoma epidemiology: implications for screening, prevention and therapy (2023, background): “…this treatment in well-selected patients is ~30 months but, owing to the heterogeneity of intermediate-stage HCC and types of procedure, ranges from 19 to 37 months in RCTs 212,214–216 , with treatment-related mortality of 0.6% (most commonly related to acute liver insufficiency) 217 (Table 3).”
EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. (2018, background): “either as single agents or in combination regimens, are doxorubicin or epirubicin, cisplatin or miriplatin.(514) These anticancer drugs have been tested amongst others on three human HCC”