90Y radioembolization versus chemoembolization in the treatment of hepatocellular carcinoma: an analysis of comparative effectiveness.
Locoregional catheter-based therapies for unresectable hepatocellular carcinoma (HCC) include conventional transarterial chemoembolization (cTACE), drug-eluting bead chemoembolization and yttrium-90 ((90)Y) radioembolization. Although current guidelines recommend cTACE for inoperable HCC, comparative effectiveness of drug-eluting bead chemoembolization and (90)Y radioembolization in the management of HCC remains undefined due to the lack of data evaluating safety and effectiveness among these therapies. A comprehensive search of the literature was carried out for studies examining comparative effectiveness of cTACE and (90)Y based on objective tumor response and overall patient survival. Further data on efficacy, safety, toxicity and cost-effectiveness was also examined. The National Cancer Institute Levels of Evidence for Cancer Treatment Studies provided a useful framework for the critical understanding and stratification of current evidence on locoregional therapy for unresectable HCC. Based on current retrospective cohort studies, evidence for similar efficacy and safety between cTACE and (90)Y radioembolization was demonstrated. Further prospective, randomized studies are required to validate these observations and to analyze cost-effectiveness of these interventions in unresectable HCC patients for definitive recommendations to be made.
Division of Interventional Radiology & Image Guided Medicine, Department of Radiology & Imaging Sciences, Emory University School of Medicine, GA, USA.
Minzhi
M
Xing
Nima
N
Kokabi
Juan C
JC
Camacho
David A
DA
Kooby
Bassel F
BF
El-Rayes
Hyun S
HS
Kim
D006528:Carcinoma, Hepatocellular / Q000191:economics / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000191:economics / Q000379:methods; D057186:Comparative Effectiveness Research; D003362:Cost-Benefit Analysis; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D006801:Humans; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000191:economics / Q000628:therapy*; D008863:Microspheres; D011446:Prospective Studies; D019275:Radiopharmaceuticals / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics
D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes