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.

Predicting hyperprogressive disease in patients with advanced hepatocellular carcinoma treated with anti-programmed cell death 1 therapy

“…PVTT is one of the most important factors contributing to poor survival in HCC. The median OS of patients with HCC and PVTT has been reported to be only 3À6 months [23]. The Child-Pugh score was also positively associated with an increased risk of HPD.…”

Sorafenib combined with embolization plus hepatic arterial infusion chemotherapy for inoperable hepatocellular carcinoma

“…For HCC with PVTT or a large nodule size, transarterial radioembolization (TARE) can prolong OS compared with sorafenib or TACE. However, patients cannot access yttrium 90 in Mainland China; thus, for patients with advanced HCC (segmental portal vein thrombosis, large nodule size, and Child-Pugh A disease) who do not have access to or are intolerant to sorafenib or TARE, TACE might be an alternative treatment[ 49 - 52 ].…”

Interventional Oncology for Hepatic Malignancy in Children

“…[55][56][57][58][59] Compared with sorafenib, TARE is a safer and more effective treatment for adults with HCC with portal vein tumor thrombosis and is associated with a lower incidence of grade 3 and 4 adverse events. 60 While TARE offers advantages over more traditional treatment modalities, several unique considerations must be taken into account prior to initiating treatment. Eligibility for TARE requires a thorough clinical history including prior therapies, and patients should meet the following inclusion criteria after discussion with a multidisciplinary care team: histological confirmation of primary or secondary liver malignancy, unequivocal magnetic resonance imaging (MRI) or computed tomography (CT) imaging of hepatic malignancy, unresectable liver disease, Karnofsky score !…”