Systematic review comparing the safety and efficacy of conventional and drug-eluting bead transarterial chemoembolization for inoperable hepatocellular carcinoma.
OBJECTIVE
Conventional transarterial chemoembolization (cTACE) is widely used for treating patients with inoperable hepatocellular carcinoma (HCC). A variation on the technique based on drug-eluting beads (DEB-TACE) has recently entered the clinic, but trials of its safety and efficacy have given conflicting results. This systematic review aimed to gain a current, comprehensive picture of how DEB-TACE compares with cTACE.


METHODS
MEDLINE, EMBASE, the Cochrane Library, the Chinese National Knowledge Infrastructure database and clinical trial registries were searched through June 2014. Risk ratios (RR), hazard ratios (HR) and 95% confidence intervals (CI) were calculated.


RESULTS
The analysis included four randomized controlled trials, one uncontrolled prospective study and one prospective case-control study, altogether involving 652 patients. Overall survival benefit was similar between cTACE and DEB-TACE patients (HR = 1.07, 95% CI = 0.82-1.40, P = 0.875). However, DEB-TACE was associated with a significantly higher objective tumor response rate (RR = 1.14, 95% CI = 1.01-1.29, P = 0.03) and a slightly lower incidence of adverse events.


CONCLUSIONS
Though the available evidence suggests that although DEB-TACE is associated with better tumor response and potentially fewer adverse events, it does not provide greater survival benefit than cTACE. These results need to be validated in high-quality trials with large sample size.
Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China.
Zhi-Bo
ZB
Xie
Xiao-Bo
XB
Wang
Yu-Chong
YC
Peng
Shao-Liang
SL
Zhu
Liang
L
Ma
Bang-De
BD
Xiang
Wen-Feng
WF
Gong
Jie
J
Chen
Xue-Mei
XM
You
Jing-Hang
JH
Jiang
Le-Qun
LQ
Li
Jian-Hong
JH
Zhong
drug-eluting beads; hepatocellular carcinoma; inoperable; meta-analysis; transarterial chemoembolization