Radiofrequency ablation vs radiation therapy vs transarterial chemoembolization vs yttrium 90 for local treatment of liver cancer – A systematic review and network meta-analysis of survival data Review
| Authors: | Chow, R.; Simone, C. B. 2nd; Jairam, M. P.; Swaminath, A.; Boldt, G.; Lock, M. |
| Review Title: | Radiofrequency ablation vs radiation therapy vs transarterial chemoembolization vs yttrium 90 for local treatment of liver cancer – A systematic review and network meta-analysis of survival data |
| Abstract: | Introduction: The comparative effectiveness of radiofrequency ablation (RFA), radiation therapy (RT), transarterial chemoembolization (TACE) and transarterial radioembolization with Yttrium-90 (Y90) relative to one another for the treatment of hepatocellular carcinoma (HCC) is unclear. The aim of this systematic review and network meta-analysis is to compare RFA to RT to TACE to Y90 in the treatment of HCC. Methods: Pubmed, Embase and Cochrane CENTRAL were searched up until April 19, 2021. Observational analyses with propensity score matched (PSM) cohort analyses and randomized controlled trials (RCT) reporting on two or more treatments relative to one another with respect to overall survival (OS) and/or progression free survival (PFS) were included. Survival data were extracted from Kaplan-Meier survival curves, and meta-analyzed using a multivariate network meta-analysis. Results: After exclusions, 24 RCTs or PSM observational studies reporting on 5549 patients were included. While 1-year OS was greater for Y90 than TACE (RR 0.85, 95% CI: 0.72–0.99), all other 1-year OS comparisons across the 4 modalities yielded similar OS, and there were no differences across any modalities in 2-year and 3-year OS. TACE had a modest PFS advantage relative to RFA (RR 0.81, 95% CI: 0.68–0.95) and RT (RR 0.65, 95% CI: 0.51–0.83) at 2 years. Conclusion: All modalities assessed resulted in similar OS, which explains the current heterogenous practice patterns. This conclusion may assist in decision making based on administrative and patient costs, and implementation of these modalities. Other factors such as toxicity rate specific to individual patients could not be assessed using network meta-analysis and may also play a role in selection of modality. Further studies, ideally using PSM cohort analyses or RCT study design, reporting on OS, PFS, local control, complete response and toxicity are needed prior to drawing definitive conclusions. © 2021 Acta Oncologica Foundation. |
| Keywords: | adult; cancer survival; controlled study; treatment outcome; aged; middle aged; retrospective studies; overall survival; review; hepatocellular carcinoma; sorafenib; chemoembolization; liver cell carcinoma; multimodality cancer therapy; carcinoma, hepatocellular; liver neoplasms; cancer radiotherapy; combined modality therapy; progression free survival; local therapy; retrospective study; systematic review; liver tumor; medline; radiation therapy; kaplan meier method; cochrane library; radiofrequency ablation; yttrium; yttrium radioisotopes; meta analysis; catheter ablation; embase; randomized controlled trial (topic); comparative effectiveness; chemoembolization, therapeutic; yttrium 90; transarterial chemoembolization; procedures; propensity score; radioembolization; yttrium-90; humans; human; male; female; network meta-analysis; transarterial radioembolization |
| Journal Title: | Acta Oncologica |
| Volume: | 61 |
| Issue: | 4 |
| ISSN: | 0284-186X |
| Publisher: | Informa Healthcare |
| Date Published: | 2022-01-01 |
| Start Page: | 484 |
| End Page: | 494 |
| Language: | English |
| DOI: | 10.1080/0284186x.2021.2009563 |
| PUBMED: | 34846988 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Review -- Export Date: 25 April 2022 -- Source: Scopus |
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