Yttrium-90 transarterial radioembolization versus conventional transarterial chemoembolization for patients with hepatocellular carcinoma: a systematic review and meta-analysis.

OBJECTIVE

To compare the effects and safety of conventional transarterial chemoembolization (cTACE) and yttrium-90 transarterial radioembolization [TARE (90Y)] for hepatocellular carcinoma (HCC).

METHODS

Nine high-quality observational studies, one low bias-risk randomized controlled trial (RCT), and one moderate bias-risk RCT included 1,652 patients [cTACE, 1,124; TARE (90Y), 528], from whom data were extracted for this systematic review and meta-analysis.

RESULTS

The extracted study outcomes included 1-year and 2-year overall survival (OS) rates, objective responses (ORs), and serious adverse events (AEs). 1-year OS rates: OR = 0.939, 95 % CI: 0.705-1.251, = 0.66. 2-year OS rates: overall pooled OR = 0.641, 95% CI: 0.382-1.075, = 0.092; observational study subgroup OR = 0.575, 95% CI: 0.336-0.984, = 0.043; RCT subgroup OR* = 0.641, 95% CI: 0.382-1.075, = 0.346. OR: overall pooled OR = 0.781, 95% CI: 0.454-1.343, = 0.371; mRECIST subgroup OR = 0.584, 95 % CI: 0.349-0.976, = 0.040; WHO subgroup OR = 1.065; 95% CI: 0.500-2.268, = 0.870. Serious AEs: overall pooled RR = 1.477, 95% CI: 0.864-2.526, = 0.154; RCT subgroup RR = 0.680, 95% CI: 0.325-1.423, = 0.306; observational study subgroup RR = 1.925; 95 % CI: 0.978-3.788, = 0.058.

CONCLUSIONS

TARE (90Y) increased 2-year OS rates in the observational subgroup and resulted in better OR rates, according to mRECIST criteria, in comparison with cTACE. Furthermore, a lower risk of AEs was observed for TARE (90Y) than for cTACE.