title: Unresectable Hepatocellular Carcinoma: Radioembolization Versus Chemoembolization: A Systematic Review and Meta-analysis.
abstract: BACKGROUND
  Transarterial radioembolization (TARE) has emerged as a newer regional therapy to transarterial chemoembolization (TACE) for treatment of unresectable hepatocellular carcinoma (HCC). The aim of this study is to compare clinical outcomes of both the techniques.
  
  
  METHODS
  Online search for studies comparing TARE to TACE from 2005 to present was performed. Primary outcome was overall survival rate for up to 4 years. Secondary outcomes included post-treatment complications and treatment response. Quality of included studies was evaluated by STrengthening the Reporting of OBservational studies in Epidemiology criteria. Relative risk (RR) and 95 % confidence intervals (CI) were calculated from pooled data.
  
  
  RESULTS
  The search strategy yielded 172 studies, five met selection criteria and included 553 patients with unresectable HCC, 284 underwent TACE and 269 underwent TARE. Median ages were 63 and 64 years for TACE and TARE, respectively. Meta-analysis showed no statistically significant difference in survival for up to 4 years between the two groups (HR = 1.06; 95 % CI 0.81-1.46, p = 0.567). TACE required at least one day of hospital stay compared to TARE which was mostly an outpatient procedure. TACE had more post-treatment pain than TARE (RR = 0.51, 95 % CI 0.36-0.72, p < 0.01), but less subjective fatigue (RR = 1.68, 95 % CI 1.08-2.62, p < 0.01). There was no difference between the two groups in the incidence of post-treatment nausea, vomiting, fever, or other complications. In addition, there was no difference in partial or complete response rates between the two groups.
  
  
  CONCLUSIONS
  TARE appears to be a safe alternative treatment to TACE with comparable complication profile and survival rates. Larger prospective randomized trials, focusing on patient-reported outcomes and cost-benefit analysis are required to consolidate these results.
authors: Division of Surgical Oncology at Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA.
authors: Laila
authors: L
authors: Lobo
authors: Division of Surgical Oncology at Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA.
authors: Danny
authors: D
authors: Yakoub
authors: Division of Surgical Oncology at Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA.
authors: Omar
authors: O
authors: Picado
authors: Division of Surgical Oncology at Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA.
authors: Caroline
authors: C
authors: Ripat
authors: Division of Surgical Oncology at Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA.
authors: Fiorella
authors: F
authors: Pendola
authors: Division of Surgical Oncology at Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA.
authors: Rishika
authors: R
authors: Sharma
authors: Division of Surgical Oncology at Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA.
authors: Rana
authors: R
authors: ElTawil
authors: Department of Biostatistics and Bioinformatics, Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA.
authors: Deukwoo
authors: D
authors: Kwon
authors: Department of Radiology, Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA.
authors: Shree
authors: S
authors: Venkat
authors: Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA.
authors: Loraine
authors: L
authors: Portelance
authors: Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA. ryechieli@med.miami.edu.|Department of Radiation Oncology, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, 1475 NW 12th Ave, Suite 1500, Miami, FL, 33136, USA. ryechieli@med.miami.edu.
authors: Raphael
authors: R
authors: Yechieli
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D003362:Cost-Benefit Analysis; D004621:Embolization, Therapeutic / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
chemical_list: D015021:Yttrium Radioisotopes
keywords: 90Y; Chemoembolization; HCC; Hepatocellular carcinoma; Radio embolization; TACE; TARE