title: Does drug-eluting bead transcatheter arterial chemoembolization improve the management of patients with hepatocellular carcinoma? A meta-analysis.
abstract: BACKGROUND
  Drug 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.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  Five 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 (χ(2) = 6.83, degrees of freedom [df] = 3; p<0.08; I(2) = 56%). Complications in both groups were assessed and no significant difference was observed (χ(2) = 6.34, degrees of freedom [df]  = 4; p<0.18; I(2)= 37%). Severe complications were also assessed and no significant difference was observed (χ(2) = 6.47, degrees of freedom [df]  = 4; p<0.17; I(2)= 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.
authors.affiliation: Department of Interventional & Vascular Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Shilong
authors.initials: S
authors.lastname: Han
authors.affiliation: Department of Interventional & Vascular Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Xiaoping
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Heart, Lung and Blood Vessel Center, Tongji University School of Medicine, Shanghai, China.
authors.forename: Liling
authors.initials: L
authors.lastname: Zou
authors.affiliation: Department of Interventional & Vascular Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Chenhui
authors.initials: C
authors.lastname: Lu
authors.affiliation: Heart, Lung and Blood Vessel Center, Tongji University School of Medicine, Shanghai, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Heart, Lung and Blood Vessel Center, Tongji University School of Medicine, Shanghai, China.
authors.forename: Jue
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Interventional & Vascular Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Maoquan
authors.initials: M
authors.lastname: Li
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000379:methods; D019468:Disease Management; D006801:Humans; D008113:Liver Neoplasms / Q000628:therapy*; D016017:Odds Ratio; D017594:Publication Bias; D016896:Treatment Outcome
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