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

Authors

  • Ronald Chow Temerty Faculty of Medicine, University of Toronto, Toronto, Canada;b New York Proton Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
  • Charles B. Simone II New York Proton Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
  • Meghan Pooja Jairam Columbia University Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
  • Anand Swaminath Juravinski Cancer Centre, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
  • Gabriel Boldt London Regional Cancer Program, London Health Sciences Centre, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada
  • Michael Lock London Regional Cancer Program, London Health Sciences Centre, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada

DOI:

https://doi.org/10.1080/0284186X.2021.2009563

Keywords:

Hepatocellular carcinoma, radiofrequency ablation, radiation therapy, transarterial chemoembolization, transarterial radioembolization, Yttrium-90, systematic review, network meta-analysis

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.

Downloads

Download data is not yet available.

Downloads

Published

2022-04-03

How to Cite

Chow, R., Simone II, C. B., Pooja Jairam, M., Swaminath, A., Boldt, G., & Lock, M. (2022). 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. Acta Oncologica, 61(4), 484–494. https://doi.org/10.1080/0284186X.2021.2009563

Issue

Vol. 61 No. 4 (2022): Acta Oncologica

Section

Articles