Does Drug-Eluting Bead Transcatheter Arterial Chemoembolization Improve the Management of Patients with Hepatocellular Carcinoma? A Meta-Analysis

Abstract

BackgroundDrug eluting beads (DEB) are relatively new embolic agents that allow sustained release of chemotherapeutic agents in a localized fashion to the tumor. This technique is associated with reduced systemic side effects relative to systemic chemotherapy and an increase in the dose of antineoplastic agent delivered to the lesion. The meta-analysis was undertaken to assess the effectiveness of DEB-transcatheter arterial chemoembolization (TACE) in the management of hepatocellular cancer.MethodsWe searched the Web of Science, PubMed, EBSCO, EMBASE, the Wiley Library and Google Scholar for studies on DEB-TACE in the management of hepatocellular cancer from 1979 to April 2013. The risk of bias was assessed using RevMan 5·1. Random and fixed-effects meta-analytical models were used where indicated, and between-study heterogeneity was assessed. Disease control, complications and severe complications were recorded.ResultsFive studies met the selection criteria, three RCTs and two case-control studies, published from 2010 to 2012, included 217 patients in the DEB-TACE group and 237 in the conventional-TACE group. There was no significance over disease control (OR 2.27, 95% CI 0.78–6.63) with moderate between-study heterogeneity (χ2 = 6.83, degrees of freedom [df] = 3; p<0.08; I2 = 56%). Complications in both groups were assessed and no significant difference was observed (χ2 = 6.34, degrees of freedom [df] = 4; p<0.18; I2 = 37%). Severe complications were also assessed and no significant difference was observed (χ2 = 6.47, degrees of freedom [df] = 4; p<0.17; I2 = 38%). No publication bias relating to the above outcomes was detected by funnel plot. DEB-TACE benefited disease control without an increase in complications and severe complications.

Transarterial chemoembolization with drug-eluting beads in hepatocellular carcinoma

“…Han et al[34] performed a meta-analysis of three RCTs and two case-control studies. Their meta-analysis included DC Beads TACE and cTACE groups comprising 217 and 237 patients, respectively.…”

Evaluation of drug-eluting beads versus conventional transcatheter arterial chemoembolization in patients with unresectable hepatocellular carcinoma: A systematic review and meta-analysis

“…However, a few studies [20][21][22][23] suggested that the two modalities were equally effective and safe. Meta-analyses to select a better TACE yielded different results [24][25][26][27][28]. We performed this meta-analysis for the following reasons:…”

Advances in transarterial therapies for hepatocellular carcinoma: is novel technology leading to better outcomes?

“…Because these studies were not designed for equivalence, there is no level 1 evidence that DEB-TACE has an equivalent efficacy to c-TACE in terms of tumor response or survival. In addition, two meta-analysis of randomized controlled trials comparing DEB-TACE and c-TACE have been recently published [40,41] and were unable to demonstrate any significant difference in the tumor response rate or in the complications rate obtained with both procedures. A more recent meta-analyses, showed that DEB-TACE provided significantly better tumor response and improved 1-and 2-year survival compared with c-TACE.…”