Transarterial Chemoembolization for Unresectable Hepatocellular Carcinoma: Meta-Analysis of Randomized Controlled Trials

Abstract

In patients with unresectable HCC, chemoembolization significantly improved the overall 2-year survival compared with nonactive treatment, but the magnitude of the benefit is relatively small.

Lipiodol transarterial chemoembolization for hepatocellular carcinoma: A systematic review of efficacy and safety data

“…As expected, we did not identify any RCT comparing lipiodol TACE versus best supportive care performed after 2002 and therefore not already included in the previous meta-analyses. (14,15) Hence, we were unable to update the results already presented concerning the survival benefit of TACE over no intervention. The other RCTs that were identified had different design and treatment arms and were focused on the comparison of different TACE techniques or protocols, (23)(24)(25)30) on the comparison of lipiodol TACE and either intravenous or transarterial chemotherapy (26,27) and on the use of lipiodol TACE alone versus lipiodol TACE combined with amiodarone or bevacizumab.…”

“…(31)(32)(33)(34)(35) Use of lipiodol TACE in the treatment of HCC is based on meta-analyses of RCTs comparing embolization or chemoembolization versus conservative management. (14,15) A recent Cochrane meta-analysis (36) whose methodology has been criticized by several experts (37,38) -questioned the evidence supporting the beneficial effect of TACE over no intervention on survival in patients with HCC. The authors of this Cochrane review advocated for more efforts to investigate the benefits of TACE through adequately powered, bias-protected trials.…”

“…(28,29) Median OS of HCC patients who received lipiodol TACE in this analysis-19.4 months-is consistent with the data reported in the previous metaanalyses. (14,15) Analysis of overall survival by year of publication showed that clinical studies published after 2002 reported longer median survival and higher 3-year survival rate than those published until 2002. OS figures suggest that different subgroups of patients can be identified according to their outcomes.…”

“…(7)(8)(9)(10)(11)(12)(13) These metaanalyses identified a distinct survival benefit for lipiodol TACE with cisplatin or doxorubicin compared to best supportive care. (14,15) As a result, Lipiodol TACE has been recommended as the standard of care for the treatment of unresectable, large, or multinodular noninvasive tumors isolated to the liver in patients who have neither evidence of hepatic decompensation nor cancer-related symptoms, that is, those cases classified as intermediate stage according to the Barcelona Clinic for Liver Cancer (BCLC) staging system. (16)(17)(18) All RCTs comparing lipiodol TACE and best supportive care in the treatment of HCC were performed more than a decade ago.…”

Phase I clinical study of a novel lipophilic platinum complex (SM-11355) in patients with hepatocellular carcinoma refractory to cisplatin/lipiodol

“…In Japan, chemoembolisation for HCC is mainly used in advanced stage patients who cannot be treated with transcatheter arterial embolisation (TAE), or whose hepatic function standby capacity is low. Furthermore, Camma et al (2002) have reported that chemoembolisation has a significant therapeutic benefit, compared with more conservative therapies, based on the data from 18 radiotherapy centres. Several attempts have been made to take advantage of the properties of lipiodol, by coinfusion of lipiodol and anticancer agents such as zinostatin stimalamer (SMANCS s ), doxorubicin, epirubicin, mitomycin C and cisplatin Kanematsu et al, 1984;Ohishi et al, 1985;Yamashita et al, 1985;Kobayashi et al, 1986;Fukushima et al, 1988;Shibata et al, 1989).…”