Combination therapy with transcatheter arterial chemoembolization and percutaneous ethanol injection compared with percutaneous ethanol injection alone for patients with small hepatocellular carcinoma

Koda, Masahiko; Murawaki, Yoshikazu; Mitsuda, Akeri; Oyama, Kenji; Okamoto, Kinya; Idobe, Youko; Suou, Takeaki; Kawasaki, Hironaka

doi:10.1002/1097-0142(20010915)92:6<1516::aid-cncr1477>3.0.co;2-i

Cited by 149 publications

(94 citation statements)

References 37 publications

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“…Ikeda et al (Cancer Chemother Pharmacol, 1992) 45 Arterial lipiodolization (ADMOS) (59) Excluded ( 46 Arterial chemotherapy (ADM ϩ CDPP ϩ oral 5-FU (15) Excluded ( 69 IV doxorubicin (n ϭ 21) Excluded (1) IV VP 16 (n ϭ 14) 49. Choi et al (Cancer, 1984) 70 IV doxorubicin (n ϭ 20) 71 IV neocarzinostatin (28) Excluded (1) IV doxorubicin (29) IV m-AMSA (24) or published only in abstract form, included patients with liver metastases, or assessed primary or secondary prevention of HCC.…”

Section: Selection Of Trialsmentioning

confidence: 96%

“…After subsequent evaluation for eligibility, we retained 61 published RCTs assessing primary treatments of HCC (Table 1). The remaining studies were excluded because they were prospective cohort studies, phase 1 or random phase 2 studies, quasi-RCTs, non-English RCTs, unpublished RCTs 24 Chemoembolization ϩ PEI (26) Excluded ( 26 Radiofrequency ablation (36) Excluded (1) Microwave coagulation (36) Arterial embolization/chemoembolization (n ϭ 17)…”

Section: Selection Of Trialsmentioning

confidence: 99%

“…The remaining 47 studies were excluded, either because they compared 2 active antitumoral treatments in 35 cases (involving percutaneous treatments [5], [22][23][24][25][26] …”

Section: Selection Of Trialsmentioning

confidence: 99%

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Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival

2003

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There is no standard treatment for patients with unresectable hepatocellular carcinoma (HCC). Survival benefits derived from medical interventions are controversial. The aim of this systematic review was to assess the evidence of the impact of medical treatments on survival. Randomized controlled trials (RCTs) that were published as full papers assessing survival for primary treatments of HCC were included. MEDLINE, the Cochrane Library, CANCERLIT, and a manual search from 1978 to May 2002 were used. The primary end point was survival, and the secondary end point was response to treatment. Estimates of effect were calculated according to the random effects model. Sensitivity analysis included methodological quality. We identified 61 randomized trials, but only 14 met the criteria to perform a meta-analysis assessing arterial embolization (7 trials, 545 patients) or tamoxifen T he incidence of hepatocellular carcinoma (HCC) is increasing worldwide. 1 Liver cancer is the fifth most common cancer in the world and the third most common cause of cancer-related death. 2 Cohort studies and cost-efficiency modeling have suggested that surveillance of well-defined cirrhotic patients may decrease tumor-related mortality. However, only 30% of patients benefit from curative therapies such as resection, transplantation, or percutaneous ablation 3 and achieve 5-year survival rates of 50% to 75%. 4 Most patients with HCC are diagnosed at intermediate to advanced stages, and there is no standard treatment for these patients. 3,4 The most reliable method to show survival advantages is to perform large randomized controlled trials (RCTs) that include more than 1,000 patients comparing treatment versus no treatment in a well-defined strata of individuals. 5-10 These investigations are lacking in patients with HCC. On the contrary, several medical interventions have been tested in the setting of small RCTs. However, the reduced size of these studies may cause questions of their statistical power when detecting survival differences, which, as in many areas of health care and oncology, are unlikely to be large. This raises the need for a systematic meta-analysis assessment, with a major role to integrate valid information and provide estimates of treatment effects when RCTs themselves are not of sufficient size. 9,10 Two systematic reviews published years ago 11,12 suggested a potential benefit for at Abbreviations: HCC, hepatocellular carcinoma; RCT, randomized controlled trial; OR, odds ratio; CI, confidence interval.

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Section: Selection Of Trialsmentioning

confidence: 96%

Section: Selection Of Trialsmentioning

confidence: 99%

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Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival

2003

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“…We also assume that patients require a mean of 2.9 treatments for RFA, 6.0 treatments for PEI, and 3.13 treatments for chemoembolization. [9][10][11][12][13][14][31][32][33] Adherence to the screening program is assumed to be 85% per year. Noncompliant patients are removed from the liver transplantation wait list.…”

Section: Assumptionsmentioning

confidence: 99%

Hepatocellular carcinoma screening in patients waiting for liver transplantation: A decision analytic model

Saab

Ly²,

Nieto

et al. 2003

Liver Transplantation

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“…Chemoembolization has also been evaluated, and is frequently used, as an adjunct to other therapies, such as resection, transplantation, percutaneous ethanol injection [64][65][66][67][68][69][70][71][72], and radiofrequency ablation [73][74][75], in the treatment of HCC. Several uncontrolled series and at least one randomized trial have suggested that preoperative chemoembolization is associated with greater mortality [57,[76][77][78].…”

Section: Hepatocellular Carcinomamentioning

confidence: 99%

Chemoembolization in the Management of Liver Tumors

Stuart

2003

The Oncologist

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The dual vascular supply of the liver affords a unique opportunity to explore intraarterial therapies for hepatic malignancies. Chemoembolization is a well-established technique combining intra-arterial chemotherapy with delivery of embolic agents in order to achieve an antitumor effect due to a high local concentration and prolonged dwell time of the drug, along with select ischemia. Many tumors, such as hepatocellular carcinoma, colorectal cancer, and neuroendocrine tumors, cause symptoms and death by local growth and destruction of the liver.While there are other methods capable of controlling small or isolated hepatic neoplasms, none are suitable for the majority of these patients. Chemoembolization can produce significant results in terms of tumor shrinkage in many of these patients, and there are studies to suggest a survival advantage in hepatocellular carcinoma. Toxicity, however, may be substantial, and patient selection is crucial in order to achieve the optimal benefit of this powerful technique for individual populations. The Oncologist 2003;8:425-437 The Oncologist 2003;8:425-437 www.TheOncologist.com

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Combination therapy with transcatheter arterial chemoembolization and percutaneous ethanol injection compared with percutaneous ethanol injection alone for patients with small hepatocellular carcinoma

Cited by 149 publications

References 37 publications

Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival

Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival

Hepatocellular carcinoma screening in patients waiting for liver transplantation: A decision analytic model

Chemoembolization in the Management of Liver Tumors

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