Transarterial chemoembolization for unresectable hepatocellular carcinoma: meta-analysis of randomized controlled trials.

By C. Cammà, F. Schepis, A. Orlando, M. Albanese, L. Shahied, F. Trevisani, P. Andreone, A. Craxì, M. Cottone. Radiology, 2002

826 citations recorded by the source corpus.

PURPOSE To review the available evidence of chemoembolization for unresectable hepatocellular carcinoma (HCC). MATERIALS AND METHODS Computerized bibliographic searches with MEDLINE and CANCERLIT databases from 1980 through 2000 were supplemented with manual searches, with the keywords "hepatocellular carcinoma," "liver cell carcinoma," "randomized controlled trial [RCT]," and "chemoembolization." Studies were included if patients with unresectable HCC were enrolled and if they were RCTs in which chemoembolization was compared with nonactive treatment (five RCTs) or if different transarterial modalities of therapy (13 RCTs) were compared. Data were extracted from each RCT according to the intention-to-treat method. Five of the RCTs with a nonactive treatment arm were combined by using the random-effects model, whereas all 18 RCTs were pooled from meta-regression analysis. RESULTS Chemoembolization significantly reduced the overall 2-year mortality rate (odds ratio, 0.54; 95% CI: 0.33, 0.89; P =.015) compared with nonactive treatment. Analysis of comparative RCTs helped to predict that overall mortality was significantly lower in patients treated with transarterial embolization (TAE) than in those treated with transarterial chemotherapy (odds ratio, 0.72; 95% CI: 0.53, 0.98; P =.039) and that there is no evidence that transarterial chemoembolization is more effective than TAE (odds ratio, 1.007; 95% CI: 0.79, 1.27; P =.95), which suggests that the addition of an anticancer drug did not improve the therapeutic benefit. CONCLUSION In patients with unresectable HCC, chemoembolization significantly improved the overall 2-year survival compared with nonactive treatment, but the magnitude of the benefit is relatively small.

Subfields: Epidemiology, Hepatology, Surgery

View Paper: https://www.semanticscholar.org/paper/eba1ae7bb5e9963534ef40da0c69cd3057c6e378

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In Hepatology

Citations in the corpus

Recent progress in understanding, diagnosing, and treating hepatocellular carcinoma (2012, background): “This same year, Camma et al published one of 2 meta-analyses comparing catheter-based treatment of HCC that did not reveal any benefit in survival with the addition of bolus intraarterial chemotherapy to bland embolization.(25) In 2006, the Society of Interventional Radiology published a consensus s”
Transarterial Therapy for Hepatocellular Carcinoma: Which Technique Is More Effective? A Systematic Review of Cohort and Randomized Studies (2007, background): “Adjuvant systemic chemotherapy has been shown to have no additional benefit compared with chemoembolization alone in two RCTs [78, 79], although suboptimal oral chemotherapy such as 5¢-deoxy-5-fluorouridine or tegafur and uracil was used.”
Image-guided tumor ablation: standardization of terminology and reporting criteria. (2005, neutral): “Other interventional oncologic therapeutic approaches, including the percutaneous delivery of genetic material and radioactive seeds and the transcatheter delivery of chemoembolization agents (10,11), may ultimately require better definition but are beyond the scope of this current position article.”