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E2246. A Meta-Analysis on the Efficacy and Complications of Yyttrium-90 Radioembolization Versus Transarterial Chemoembolization
Authors
  1. Nicholas Cleveland; Geisinger Medical Center
  2. Yirui Hu; Geisinger Medical Center
  3. Tariq Rahman; Geisinger Medical Center
  4. Steven Bonebrake; Geisinger Medical Center
  5. Charles Martin; Cleveland Clinic Foundation
Objective:
A meta-analysis was conducted to help elucidate the efficacy and complications of transarterial chemoembolization (TACE) techniques versus transarterial radioembolization (TARE) in treating patients with unresectable hepatocellular carcinoma (HCC).

Materials and Methods:
Eight case-control studies, two cohort studies, and two randomized controlled trials were identified through PubMed and Google Scholar. A total of 2,028 patients were subdivided into 1,115 conventional TACE (cTACE), 317 drug-eluting bead TACE (D-TACE), and 596 TARE patient treatment groups. Random-effects meta-analyses were performed for the tumor response, overall survival, and adverse events (AE). Risk ratios (RRs) and 95% confidence intervals (CIs) were initially calculated for binary outcomes from the included studies. Each included study’s pooled estimates and measures of variability were used to generate forest plots, by subgroups of cTACE vs. TARE and D-TACE vs. TARE. The quantile estimation method was applied to estimate the pooled raw difference of median survival between interventions.

Results:
No significant difference was found in tumor overall response (RR = 1.18, 95% CI: 0.81-1.74) or median overall survival (-1.0157, 95% CI -3.9734-1.9420, p = .5) between patients treated with conventional TACE versus TARE. However, we found that patients receiving TARE therapy had significantly less post-treatment abdominal pain than patients undergoing conventional TACE (RR = 2.79, 95% CI: 1.31-5.97). Unfortunately, we did not have enough data to sufficiently compare drug-eluting bead TACE and TARE.

Conclusion:
This meta-analysis suggests that TARE therapy may contribute to less post-treatment pain versus conventional TACE. No other definitive clinical advantages of TARE therapy were found in this study. Ultimately, more robust multicenter randomized controlled trials with set protocols are needed in order to further elucidate the true benefits of these treatment modalities.