Transarterial chemoembolization with 125 I seed insertion for unresectable hepatocellular carcinoma: a meta‑analysis

Area of Science:

• Oncology
• Interventional Radiology
• Medical Physics

Background:

• Hepatocellular cancer (HCC) is a common malignancy, often treated with Transarterial Chemoembolization (TACE) for unresectable cases.
• Percutaneous insertion of 125I seeds post-TACE is explored to enhance treatment efficacy.
• This meta-analysis evaluates the combined TACE and 125I seed insertion (TACE-I) approach against TACE alone.

Purpose of the Study:

• To compare the safety and efficacy of TACE-I versus TACE alone in managing inoperable HCC.
• To assess key oncological outcomes including objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and overall survival (OS).
• To evaluate the incidence of adverse events associated with both treatment modalities.

Main Methods:

• A systematic meta-analysis of studies from PubMed, Cochrane Library, and Wanfang databases up to October 2024.
• Inclusion criteria focused on comparative studies of TACE-I and TACE alone for inoperable HCC.
• Primary endpoint was ORR; secondary endpoints included DCR, PFS, OS, and adverse events.

Main Results:

• TACE-I demonstrated superior ORR (P<0.001), PFS (P<0.001), and OS (P<0.001) compared to TACE alone.
• DCR (P=0.77) and adverse event rates (fever, vomiting, myelosuppression) were comparable between the groups.
• Significant heterogeneity was noted for OS (I2=73%), and publication bias was detected for ORR, DCR, and OS.

Conclusions:

• TACE-I is a safe and effective treatment for inoperable HCC, offering improved efficacy and survival benefits over TACE alone.
• The addition of 125I seeds enhances TACE outcomes without significantly increasing adverse events.
• Further research may be warranted to address heterogeneity and publication bias in OS outcomes.