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Erschienen in: Journal of Cancer Research and Clinical Oncology 3/2012

01.03.2012 | Original Paper

Comparison of transcatheter arterial chemoembolization and microsphere embolization for treatment of unresectable hepatocellular carcinoma: a meta-analysis

verfasst von: Feng Xie, Jiajie Zang, Xiaojing Guo, Feng Xu, Rongxi Shen, Long Yan, Jiamei Yang, Jia He

Erschienen in: Journal of Cancer Research and Clinical Oncology | Ausgabe 3/2012

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Abstract

Purpose

Survival of patients with surgically unresectable hepatocellular carcinoma (HCC) is very poor due to the limited effective treatments available. Transhepatic arterial chemoembolization (TACE) and microsphere embolization may offer hope for such patients; however, to date, their efficacy has not been evaluated. This study was designed to compare the effectiveness of these two treatments for patients with unresectable HCC.

Methods

This meta-analysis searched literature using various databases and revealed 13 studies on surgically unresectable HCC patients treated with TACE or microsphere embolization. Response rate, 1-year survival, overall survival, and time to progression were then analyzed and compared.

Results

These thirteen studies included 597 and 1,233 patients with unresectable HCC for microsphere embolization and chemoembolization treatments, respectively. The data showed that microsphere embolization therapy was significantly better for longer overall survival, 1-year survival, longer time to progression, and complete or partial response rate than that of chemoembolization treatment.

Conclusions

These data demonstrated that microsphere embolization treatment of patients with surgically unresectable HCC provided much better survival and treatment response than that of TACE.
Literatur
Zurück zum Zitat Ahmad J, Rhee J, Carr BI (2005) The effects of hepatic artery chemotherapy on viral hepatitis in patients with hepatocellular carcinoma. Dig Dis Sci 50:331–335PubMedCrossRef Ahmad J, Rhee J, Carr BI (2005) The effects of hepatic artery chemotherapy on viral hepatitis in patients with hepatocellular carcinoma. Dig Dis Sci 50:331–335PubMedCrossRef
Zurück zum Zitat Bartolozzi C, Lencioni R, Caramella D, Vignali C, Cioni R, Mazzeo S et al (1995) Treatment of large HCC: transcatheter arterial chemoembolization combined with percutaneous ethanol injection versus repeated transcatheter arterial chemoembolization. Radiology 197:812–818PubMed Bartolozzi C, Lencioni R, Caramella D, Vignali C, Cioni R, Mazzeo S et al (1995) Treatment of large HCC: transcatheter arterial chemoembolization combined with percutaneous ethanol injection versus repeated transcatheter arterial chemoembolization. Radiology 197:812–818PubMed
Zurück zum Zitat Bruix J, Sherman M, Practice Guidelines Committee, American Association for the Study of Liver Diseases (2005) Management of hepatocellular carcinoma. Hepatology 42:1208–1236PubMedCrossRef Bruix J, Sherman M, Practice Guidelines Committee, American Association for the Study of Liver Diseases (2005) Management of hepatocellular carcinoma. Hepatology 42:1208–1236PubMedCrossRef
Zurück zum Zitat Burton MA, Gray BN, Klemp PF, Kelleher DK, Hardy N (1989) Selective internal radiation therapy: distribution of radiation in the liver. Eur J Cancer Clin Oncol 25:1487–1491PubMedCrossRef Burton MA, Gray BN, Klemp PF, Kelleher DK, Hardy N (1989) Selective internal radiation therapy: distribution of radiation in the liver. Eur J Cancer Clin Oncol 25:1487–1491PubMedCrossRef
Zurück zum Zitat Cao GW, Hu S, Li G et al (2005a) The clinical and experimental research of transhepatic arterial injection of 32P-glass microsphere therapy for hepatic carcinoma. J Med Imaging 15(8):678–681 Cao GW, Hu S, Li G et al (2005a) The clinical and experimental research of transhepatic arterial injection of 32P-glass microsphere therapy for hepatic carcinoma. J Med Imaging 15(8):678–681
Zurück zum Zitat Cao XC, Wang X, Tan J, Li B, Wang R, Liu Y, Chang Y, Zhang L, Wang J, Yan S (2005b) Clinical research of intra-arterial radioembolization with 32P-gass microspheres combined with chemoembolization for treatment of liver cancer. Chin J Radiol 39(10):1068–1072 Cao XC, Wang X, Tan J, Li B, Wang R, Liu Y, Chang Y, Zhang L, Wang J, Yan S (2005b) Clinical research of intra-arterial radioembolization with 32P-gass microspheres combined with chemoembolization for treatment of liver cancer. Chin J Radiol 39(10):1068–1072
Zurück zum Zitat Carr BI (2004) Hepatic arterial 90 yttrium glass microspheres (Therasphere) for unresectable hepatocellular carcinoma: interim safety and survival data on 65 patients. Liver Transplant 10:S107–S110CrossRef Carr BI (2004) Hepatic arterial 90 yttrium glass microspheres (Therasphere) for unresectable hepatocellular carcinoma: interim safety and survival data on 65 patients. Liver Transplant 10:S107–S110CrossRef
Zurück zum Zitat Carr BI, Kondragunta V, Buch SC, Branch RA (2010) Therapeutic equivalence in survival for hepatic arterial chemoembolization and yttrium 90 microsphere treatments in unresectable hepatocellular carcinoma. Cancer 116:1305–1314PubMedCrossRef Carr BI, Kondragunta V, Buch SC, Branch RA (2010) Therapeutic equivalence in survival for hepatic arterial chemoembolization and yttrium 90 microsphere treatments in unresectable hepatocellular carcinoma. Cancer 116:1305–1314PubMedCrossRef
Zurück zum Zitat Cheng AL, Kang YK, Chen Z et al (2009) Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomised, double-blind, placebo-controlled trial. Lancet Oncol 10:25–34PubMedCrossRef Cheng AL, Kang YK, Chen Z et al (2009) Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomised, double-blind, placebo-controlled trial. Lancet Oncol 10:25–34PubMedCrossRef
Zurück zum Zitat Du W, Lin S, Luo K et al (2002) Clinical analysis of TACE plus 32P-GMS in advanced hepatic carcinoma. J Hepatobilia Surg 10(5):351–352 Du W, Lin S, Luo K et al (2002) Clinical analysis of TACE plus 32P-GMS in advanced hepatic carcinoma. J Hepatobilia Surg 10(5):351–352
Zurück zum Zitat Goin JE, Dancey JE, Roberts CA, Sickles CJ, Leung DA, Soulen MC (2004) Comparison of post-embolization syndrome in the treatment of patients with unresectable hepatocellular carcinoma: transcatheter arterial chemo-embolization versus yttrium-90 glass microspheres. World J Nuc Med 3:49–56 Goin JE, Dancey JE, Roberts CA, Sickles CJ, Leung DA, Soulen MC (2004) Comparison of post-embolization syndrome in the treatment of patients with unresectable hepatocellular carcinoma: transcatheter arterial chemo-embolization versus yttrium-90 glass microspheres. World J Nuc Med 3:49–56
Zurück zum Zitat Gray B, Van Hazel G, Hope M et al (2001) Randomised trial of SIR-Spheres plus chemotherapy versus chemotherapy alone for treating patients with liver metastases from primary large bowel cancer. Ann Oncol 12:1711–1720PubMedCrossRef Gray B, Van Hazel G, Hope M et al (2001) Randomised trial of SIR-Spheres plus chemotherapy versus chemotherapy alone for treating patients with liver metastases from primary large bowel cancer. Ann Oncol 12:1711–1720PubMedCrossRef
Zurück zum Zitat Hao N, Xiao X, Han X et al (2000) Efficacy of intra-arterial chemoembolization using drug microspheres in compare with chemoembolization in the treatment of primary hepatic carcinoma. Tumor (Shanghai) 20(5):375–378 Hao N, Xiao X, Han X et al (2000) Efficacy of intra-arterial chemoembolization using drug microspheres in compare with chemoembolization in the treatment of primary hepatic carcinoma. Tumor (Shanghai) 20(5):375–378
Zurück zum Zitat Heckman JT, Devera MB, Marsh JW et al (2008) Bridging locoregional therapy for hepatocellular carcinoma prior to liver transplantation. Ann Surg Oncol 15:3169–3177PubMedCrossRef Heckman JT, Devera MB, Marsh JW et al (2008) Bridging locoregional therapy for hepatocellular carcinoma prior to liver transplantation. Ann Surg Oncol 15:3169–3177PubMedCrossRef
Zurück zum Zitat Hou P, Guan G, Zhang X, Lu H, Wang S (2006) Effects of intra-advanced 32P glass microspheres for advanced hepatic carcinoma. Academic journal of Fujian medical university 40(1):48–50 Hou P, Guan G, Zhang X, Lu H, Wang S (2006) Effects of intra-advanced 32P glass microspheres for advanced hepatic carcinoma. Academic journal of Fujian medical university 40(1):48–50
Zurück zum Zitat Ibrahim SM, Lewandowski RJ, Ryu RK et al (2008) Radiographic response to yttrium-90 radioembolization in anterior versus posterior liver segments. Cardiovasc Intervent Radiol 31:1124–1132PubMedCrossRef Ibrahim SM, Lewandowski RJ, Ryu RK et al (2008) Radiographic response to yttrium-90 radioembolization in anterior versus posterior liver segments. Cardiovasc Intervent Radiol 31:1124–1132PubMedCrossRef
Zurück zum Zitat Kirchhoff TD, Rudolph KL, Layer G, Chavan A, Greten TF, Rosenthal H, Kubicka S, Galanski M, Manns MP, Schild H, Gallkowski U (2006) Chemoocclusion vs. chemoperfusion for treatment of advanced hepatocellular carcinoma: a randomised trial. Eur J Surg Oncol 32(2):201–207 Kirchhoff TD, Rudolph KL, Layer G, Chavan A, Greten TF, Rosenthal H, Kubicka S, Galanski M, Manns MP, Schild H, Gallkowski U (2006) Chemoocclusion vs. chemoperfusion for treatment of advanced hepatocellular carcinoma: a randomised trial. Eur J Surg Oncol 32(2):201–207
Zurück zum Zitat Kooby DA, Egnatashvili V, Srinivasan S, Chamsuddin A, Delman KA, Kauh J, Staley CA III, Kim HS (2009) Comparison of yttrium-90 radioembolization and transcatheter arterial chemoembolization for the treatment of unresectable hepatocellular carcinoma. J Vasc Interv Radiol 21(2):224–230PubMedCrossRef Kooby DA, Egnatashvili V, Srinivasan S, Chamsuddin A, Delman KA, Kauh J, Staley CA III, Kim HS (2009) Comparison of yttrium-90 radioembolization and transcatheter arterial chemoembolization for the treatment of unresectable hepatocellular carcinoma. J Vasc Interv Radiol 21(2):224–230PubMedCrossRef
Zurück zum Zitat Kulik LM, Atassi B, van Holsbeeck L, Souman T, Lewandowski RJ, Mulcahy MF, Hunter RD, Nemcek AA Jr, Abecassis MM, Haines KG III, Salem R (2006) Yttrium-90 microspheres (TheraSphere) treatment of unresectable hepatocellular carcinoma: down staging to resection, RFA and bridge to transplantation. J Surg Oncol 94:572–586PubMedCrossRef Kulik LM, Atassi B, van Holsbeeck L, Souman T, Lewandowski RJ, Mulcahy MF, Hunter RD, Nemcek AA Jr, Abecassis MM, Haines KG III, Salem R (2006) Yttrium-90 microspheres (TheraSphere) treatment of unresectable hepatocellular carcinoma: down staging to resection, RFA and bridge to transplantation. J Surg Oncol 94:572–586PubMedCrossRef
Zurück zum Zitat Kulik LM, Carr BI, Mulcahy MF et al (2008) Safety and efficacy of 90Y radiotherapy for hepatocellular carcinoma with and without portal vein thrombosis. Hepatology 47:71–81PubMedCrossRef Kulik LM, Carr BI, Mulcahy MF et al (2008) Safety and efficacy of 90Y radiotherapy for hepatocellular carcinoma with and without portal vein thrombosis. Hepatology 47:71–81PubMedCrossRef
Zurück zum Zitat Lau WY, Ho S, Leung TW et al (1998) Selective internal radiation therapy for non resectable hepatocellular carcinoma with intraarterial infusion of 90 yttrium microspheres. Int J Radiat Oncol Biol Phys 40:583–592PubMedCrossRef Lau WY, Ho S, Leung TW et al (1998) Selective internal radiation therapy for non resectable hepatocellular carcinoma with intraarterial infusion of 90 yttrium microspheres. Int J Radiat Oncol Biol Phys 40:583–592PubMedCrossRef
Zurück zum Zitat Lee W, Luo J, Yan Z et al (2008) Hepatic radioembolization with epirubicin mixed microsphere for the treatment of hepatocellular carcinoma. J Nantong Univ (Medical Sciences) 28(4):268–270 Lee W, Luo J, Yan Z et al (2008) Hepatic radioembolization with epirubicin mixed microsphere for the treatment of hepatocellular carcinoma. J Nantong Univ (Medical Sciences) 28(4):268–270
Zurück zum Zitat Leelawat K, Laisupasin P, Kiatdilokrut A et al (2008) The effect of doxorubicin on the changes of serum vascular endothelial growth factor (VEGF) in patients with hepatocellular carcinoma after transcatheter arterial chemoembolization (TACE). J Med Assoc Thai 91:1539–1543PubMed Leelawat K, Laisupasin P, Kiatdilokrut A et al (2008) The effect of doxorubicin on the changes of serum vascular endothelial growth factor (VEGF) in patients with hepatocellular carcinoma after transcatheter arterial chemoembolization (TACE). J Med Assoc Thai 91:1539–1543PubMed
Zurück zum Zitat Lencioni R, Cioni D, Crocetti L et al (2005) Early-stage hepatocellular carcinoma in patients with cirrhosis: long-term results of percutaneous image-guided radiofrequency ablation. Radiology 234:961–967PubMedCrossRef Lencioni R, Cioni D, Crocetti L et al (2005) Early-stage hepatocellular carcinoma in patients with cirrhosis: long-term results of percutaneous image-guided radiofrequency ablation. Radiology 234:961–967PubMedCrossRef
Zurück zum Zitat Lewandowski RJ, Kulik LM, Riaz A, Senthilnathan S, Mulcahy MF, Ryu RK, Ibrahim SM, Sato KT, Baker T, Miller FH, Omary R, Abecassis M, Salem R (2009) A comparative analysis of transarterial downstaging for hepatocellular carcinoma: chemoembolization versus radioembolization. Am J Transplant 9(8):1920–1928PubMedCrossRef Lewandowski RJ, Kulik LM, Riaz A, Senthilnathan S, Mulcahy MF, Ryu RK, Ibrahim SM, Sato KT, Baker T, Miller FH, Omary R, Abecassis M, Salem R (2009) A comparative analysis of transarterial downstaging for hepatocellular carcinoma: chemoembolization versus radioembolization. Am J Transplant 9(8):1920–1928PubMedCrossRef
Zurück zum Zitat Lewandowski RJ, Mulcahy MF, Kulik LM et al (2010) Chemoembolization for hepatocellular carcinoma: comprehensive imaging and survival analysis in a 172-patient cohort. Radiology 255:955–965PubMedCrossRef Lewandowski RJ, Mulcahy MF, Kulik LM et al (2010) Chemoembolization for hepatocellular carcinoma: comprehensive imaging and survival analysis in a 172-patient cohort. Radiology 255:955–965PubMedCrossRef
Zurück zum Zitat Liu T, Zu M (2005) Treatment of primary hepatic carcinoma by hepatic arterial chemoembolization with KMG microspheres and chemotherapeutic agents. Acad Med Xuzhou 25(2):126–129 Liu T, Zu M (2005) Treatment of primary hepatic carcinoma by hepatic arterial chemoembolization with KMG microspheres and chemotherapeutic agents. Acad Med Xuzhou 25(2):126–129
Zurück zum Zitat Llovet JM, Bruix J (2003) Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology 37:429–442PubMedCrossRef Llovet JM, Bruix J (2003) Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology 37:429–442PubMedCrossRef
Zurück zum Zitat Llovet JM, Real MI, Montana X et al (2002) Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 359:1734–1739PubMedCrossRef Llovet JM, Real MI, Montana X et al (2002) Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 359:1734–1739PubMedCrossRef
Zurück zum Zitat Lo CM, Ngan H, Tso WK et al (2002) Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 35:1164–1171PubMedCrossRef Lo CM, Ngan H, Tso WK et al (2002) Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 35:1164–1171PubMedCrossRef
Zurück zum Zitat Mathurin P, Rixe O, Carbonell N, Bernard B, Cluzel P, Bellin MF et al (1998) Review article: overview of medical treatments in unresectable hepatocellular carcinoma-an impossible meta-analysis? Aliment Pharmacol Ther 12:111–126PubMedCrossRef Mathurin P, Rixe O, Carbonell N, Bernard B, Cluzel P, Bellin MF et al (1998) Review article: overview of medical treatments in unresectable hepatocellular carcinoma-an impossible meta-analysis? Aliment Pharmacol Ther 12:111–126PubMedCrossRef
Zurück zum Zitat Mazzaferro V, Regalia E, Doci R et al (1996) Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 334:693–699PubMedCrossRef Mazzaferro V, Regalia E, Doci R et al (1996) Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 334:693–699PubMedCrossRef
Zurück zum Zitat Parkin DM, Bray F, Ferlay J, Pisani P (2001) Estimating the world cancer burden: globocan 2000. Int J Cancer 94:153–156PubMedCrossRef Parkin DM, Bray F, Ferlay J, Pisani P (2001) Estimating the world cancer burden: globocan 2000. Int J Cancer 94:153–156PubMedCrossRef
Zurück zum Zitat Parmar MK, Torri V, Stewart L (1998) Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints. Stat Med 17:2815–2834PubMedCrossRef Parmar MK, Torri V, Stewart L (1998) Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints. Stat Med 17:2815–2834PubMedCrossRef
Zurück zum Zitat Poon RT, Ngan H, Lo CM, Liu CL, Fan ST, Wong J (2000) Transarterial chemoembolization for inoperable hepatocellular carcinoma and postresection intrahepatic recurrence. J Surg Oncol 73:109–114PubMedCrossRef Poon RT, Ngan H, Lo CM, Liu CL, Fan ST, Wong J (2000) Transarterial chemoembolization for inoperable hepatocellular carcinoma and postresection intrahepatic recurrence. J Surg Oncol 73:109–114PubMedCrossRef
Zurück zum Zitat Salem R, Lewandowski RJ, Kulik L, Wang E, Riaz A, Ryu RK, Sato KT, Gupta R, Nikolaidis P, Miller FH, Yaghmai V, Ibrahim SM, Senthilnathan S, Baker T, Gates VL, Atassi B, Newman S, Memon K, Chen R, Vogelzang RL, Nemcek AA, Resnick SA, Chrisman HB, Carr J, Omary RA, Abecassis M, Benson AB 3rd, Mulcahy MF (2011) Radioembolization results in longer time-to-progression and reduced toxicity compared with chemoembolization in patients with hepatocellular carcinoma. Gastroenterology 140(2):497–507PubMedCrossRef Salem R, Lewandowski RJ, Kulik L, Wang E, Riaz A, Ryu RK, Sato KT, Gupta R, Nikolaidis P, Miller FH, Yaghmai V, Ibrahim SM, Senthilnathan S, Baker T, Gates VL, Atassi B, Newman S, Memon K, Chen R, Vogelzang RL, Nemcek AA, Resnick SA, Chrisman HB, Carr J, Omary RA, Abecassis M, Benson AB 3rd, Mulcahy MF (2011) Radioembolization results in longer time-to-progression and reduced toxicity compared with chemoembolization in patients with hepatocellular carcinoma. Gastroenterology 140(2):497–507PubMedCrossRef
Zurück zum Zitat Sato K, Lewandowski RJ, Bui JT et al (2006) Treatment of unresectable primary and metastatic liver cancer with Yttrium-90 microspheres (TheraSphere): assessment of hepatic arterial embolization. Cardiovasc Intervent Radiol 29:522–529PubMedCrossRef Sato K, Lewandowski RJ, Bui JT et al (2006) Treatment of unresectable primary and metastatic liver cancer with Yttrium-90 microspheres (TheraSphere): assessment of hepatic arterial embolization. Cardiovasc Intervent Radiol 29:522–529PubMedCrossRef
Zurück zum Zitat Simonetti RG, Liberati A, Angiolini C, Pagliaro L (1997) Treatment of hepatocellular carcinoma: a systematic review of randomized controlled trials. Ann Oncol 8:117–136PubMedCrossRef Simonetti RG, Liberati A, Angiolini C, Pagliaro L (1997) Treatment of hepatocellular carcinoma: a systematic review of randomized controlled trials. Ann Oncol 8:117–136PubMedCrossRef
Zurück zum Zitat Virmani S, Rhee TK, Ryu RK et al (2008) Comparison of hypoxiainducible factor-1a expression before and after transcatheter arterial embolization in rabbit VX2 liver tumors. J Vasc Interv Radiol 19:1483–1489PubMedCrossRef Virmani S, Rhee TK, Ryu RK et al (2008) Comparison of hypoxiainducible factor-1a expression before and after transcatheter arterial embolization in rabbit VX2 liver tumors. J Vasc Interv Radiol 19:1483–1489PubMedCrossRef
Metadaten
Titel
Comparison of transcatheter arterial chemoembolization and microsphere embolization for treatment of unresectable hepatocellular carcinoma: a meta-analysis
verfasst von
Feng Xie
Jiajie Zang
Xiaojing Guo
Feng Xu
Rongxi Shen
Long Yan
Jiamei Yang
Jia He
Publikationsdatum
01.03.2012
Verlag
Springer-Verlag
Erschienen in
Journal of Cancer Research and Clinical Oncology / Ausgabe 3/2012
Print ISSN: 0171-5216
Elektronische ISSN: 1432-1335
DOI
https://doi.org/10.1007/s00432-011-1117-7

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