Transarterial radioembolization versus chemoembolization for hepatocarcinoma patients: a meta-analysis of randomized trial

Abstract

Introduction: A novel technique of loco-regional treatments for HCC is called transarterial radioembolization with yttrium-90 (TARE), which induces tumor necrosis by means of injection of glass or resin microsphere loaded with yttrium-90. TARE, which is in fact a novel form of liver-directed brachytherapy. Although several studies comparing the two locoregional techniques have been recently published, whether there is a clear superiority of one treatment over the other is still debated. In this study, we performed a meta-analysis to compare the efficacy of TARE and TACE in treating patients with unresectable HCC and we considering only the three randomized study. Materials and methods: Randomized controlled studies that included patients with intermediate hepatocellular carcinoma were included in to the analysis. Results: A total of 3 studies published from 2014 to 2016 were analyzed, which included 49 HCC patients treated with TARE and 48 who underwent TACE. A significant between the trials' heterogeneity was detected for PFS (I2 test 78%), while no heterogeneity was detected for the other outcomes. OS at 1 year was similarity between the two treatment groups (OR=1.21, 95%CI: 0.51-2.83, P=0.67). Overall survival at 1 year was 63.2% for TARE compare to 66.6% for TACE. For PFS at 1 years the data were not statistical significant between two treatment (OR=0.25, 95%CI: 0.02-3.03, p=0.28). We also analysed progression disease, disease control rate and transplanted patients. For progression disease and disease control rate not statistical significant was detect. For progression disease the OR was 0.61 (95%CI: 0.14-2.70, p=0.51) and for disease control rate the OR was 1.80 (95%CI: 0.51-6.30, p=0.36). For transplatate patients the OR was 0.68 (95%CI: 0.23-2.01, p=0.49). In the group treatment with TARE the ttransplanted patients were 30% compared to 20.8% of patients treatment with TACE. Conclusion: Our meta-analysis reveals that TARE and TACE show similar effects in unresectable HCC patients in terms of OS, disease control rate, patients transplantate and progression disease. However, important evidence emerging from the various studies and this meta-analysis is that TARE seems to have a greater down-staging compared to TACE especially in early-stage patients.