Comparison of radioembolization and sorafenib for the treatment of hepatocellular carcinoma with portal vein tumor thrombosis: A systematic review and meta-analysis of safety and efficacy

Abstract

Objective: To compare the safety and efficacy of radioembolization with that of sorafenib for the treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT). Materials and Methods: MEDLINE, EMBASE, and Cochrane databases were searched for studies reporting outcomes in patients with HCC and PVTT treated with radioembolization or sorafenib. Meta-analyses of cumulative overall survival (OS) and Kaplan-Meier survival rates according to the time to progression (TTP) and incidence of adverse events (AEs) were performed. Subgroup analyses were conducted on 1-year OS data. Results: Seventeen studies were identified (four involving radioembolization, 10 involving sorafenib, and three comparing both). Pooled OS rates were higher in the radioembolization group, notably at 6 months {76% (95% confidence interval [CI], 64-85%) vs. 54% (95% CI, 45-62%)} and 1 year (47% [95% CI, 38-57%] vs. 24% [95% CI, 18-30%]); TTP was also longer with radioembolization. In patients undergoing radioembolization, the proportion of patients with Eastern Cooperative Oncology Group status 0 (p < 0.0001), Child-Pugh A (p < 0.0001), extrahepatic metastasis (p = 0.0012), and a history of cancer treatment (p = 0.0048) was identified as a significant source of heterogeneity for the 1-year OS. Radioembolization was associated with a lower incidence of grade 3/4 AEs than sorafenib (9% [95% CI, 3-27%] vs. 28% [95% CI, 17-43%]). Conclusion: Compared with sorafenib, radioembolization is a safer and more effective treatment for HCC with PVTT and is associated with prolonged survival, delayed tumor progression, and fewer grade 3/4 AEs.