title: Trans-arterial radioembolization in intermediate-advanced hepatocellular carcinoma: systematic review and meta-analyses.
abstract: Trans-arterial radioembolization (TARE) is a recognized, although not explicitly recommended, experimental therapy for unresectable hepatocellular carcinoma (HCC).A systematic literature review was performed to identify published studies on the use of TARE in intermediate and advanced stages HCC exploring the efficacy and safety of this innovative treatment.Twenty-one studies reporting data on overall survival (OS) and time to progression (TTP), were included in a meta-analysis. The pooled post-TARE OS was 63% (95% CI: 56-70%) and 27% (95% CI: 21-33%) at 1- and 3-years respectively in intermediate stage HCC, whereas OS was 37% (95% CI: 26-50%) and 13% (95% CI: 9-18%) at the same time intervals in patients with sufficient liver function (Child-Pugh A-B7) but with an advanced HCC because of the presence of portal vein thrombosis. When an intermediate and advanced case-mix was considered, OS was 58% (95% CI: 48-67%) and 17% (95% CI: 12-23%) at 1- and 3-years respectively. As for TTP, only four studies reported data: the observed progression probability was 56% (95% CI: 41-70%) and 73% (95% CI: 56-87%) at 1 and 2 years respectively. The safety analysis, focused on the risk of liver decompensation after TARE, revealed a great variability, from 0-1% to more than 36% events, influenced by the number of procedures, patient Child-Pugh stage and treatment duration.Evidence supporting the use of radioembolization in HCC is mainly based on retrospective and prospective cohort studies. Based on this evidence, until the results of the ongoing randomized trials become available, radioembolization appears to be a viable treatment option for intermediate-advanced stage HCC.
authors: Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy.
authors: Carla
authors: C
authors: Rognoni
authors: Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy.|Evidence Synthesis and Modelling for Health Improvement (ESMI), University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, UK.
authors: Oriana
authors: O
authors: Ciani
authors: Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy.
authors: Silvia
authors: S
authors: Sommariva
authors: Department of Surgery, Liver Surgery, Transplantation and Gastroenterology, Istituto Nazionale Tumori Fondazione IRCCS, National Cancer Institute of Milan, and University of Milan, Milan, Italy.
authors: Antonio
authors: A
authors: Facciorusso
authors: Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy.|Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy.
authors: Rosanna
authors: R
authors: Tarricone
authors: Department of Surgery, Liver Surgery, Transplantation and Gastroenterology, Istituto Nazionale Tumori Fondazione IRCCS, National Cancer Institute of Milan, and University of Milan, Milan, Italy.
authors: Sherrie
authors: S
authors: Bhoori
authors: Department of Surgery, Liver Surgery, Transplantation and Gastroenterology, Istituto Nazionale Tumori Fondazione IRCCS, National Cancer Institute of Milan, and University of Milan, Milan, Italy.
authors: Vincenzo
authors: V
authors: Mazzaferro
mesh_terms: D001918:Brachytherapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D057785:Catheters; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D018450:Disease Progression; D006801:Humans; D017093:Liver Failure / Q000453:epidemiology / Q000209:etiology; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D064887:Observational Studies as Topic; D011169:Portal Vein / Q000473:pathology; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000209:etiology; D015021:Yttrium Radioisotopes / Q000008:administration & dosage
chemical_list: D015021:Yttrium Radioisotopes
keywords: advanced stage; hepatocellular carcinoma; intermediate stage; meta-analysis; trans-arterial radioembolization