Transarterial (chemo)embolisation for unresectable hepatocellular carcinoma

Area of Science:

• Hepatobiliary Medicine
• Interventional Radiology
• Oncology

Background:

• Hepatocellular carcinoma (HCC) is a leading cause of cancer death globally.
• Transarterial chemoembolisation (TACE) and transarterial embolisation (TAE) are standard treatments for unresectable HCC.

Purpose of the Study:

• To evaluate the efficacy and safety of TACE or TAE in patients with unresectable HCC.
• To assess the impact of TACE and TAE on overall survival and quality of life.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs).
• Searched multiple databases up to September 2010 for trials comparing TACE/TAE versus control.
• Analyzed all-cause mortality using random-effects models and validated with trial sequential analyses.

Main Results:

• Nine trials with 645 participants were included; heterogeneity was low to moderate.
• Meta-analysis showed no significant survival benefit for TACE or TAE versus control (HR 0.88; 95% CI 0.71 to 1.10).
• Trial sequential analysis indicated insufficient evidence for survival benefits, necessitating further trials. Adverse events were reported.

Conclusions:

• Current evidence does not firmly support or refute the use of TACE or TAE for unresectable HCC.
• More high-quality, adequately powered, and bias-protected randomized trials are required to establish the true efficacy and safety of these interventions.