Korean J Radiol.  2019 Mar;20(3):385-398. 10.3348/kjr.2018.0496.

Comparison of Radioembolization and Sorafenib for the Treatment of Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis: A Systematic Review and Meta-Analysis of Safety and Efficacy

• Kim PH
• Choi SH
• Kim JH
• Park SH

• KMID: 2438268
• DOI: http://doi.org/10.3348/kjr.2018.0496

Abstract

OBJECTIVE
To compare the safety and efficacy of radioembolization with that of sorafenib for the treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT).
MATERIALS AND METHODS
MEDLINE, EMBASE, and Cochrane databases were searched for studies reporting outcomes in patients with HCC and PVTT treated with radioembolization or sorafenib. Meta-analyses of cumulative overall survival (OS) and Kaplan-Meier survival rates according to the time to progression (TTP) and incidence of adverse events (AEs) were performed. Subgroup analyses were conducted on 1-year OS data.
RESULTS
Seventeen studies were identified (four involving radioembolization, 10 involving sorafenib, and three comparing both). Pooled OS rates were higher in the radioembolization group, notably at 6 months {76% (95% confidence interval [CI], 64-85%) vs. 54% (95% CI, 45-62%)} and 1 year (47% [95% CI, 38-57%] vs. 24% [95% CI, 18-30%]); TTP was also longer with radioembolization. In patients undergoing radioembolization, the proportion of patients with Eastern Cooperative Oncology Group status 0 (p < 0.0001), Child-Pugh A (p < 0.0001), extrahepatic metastasis (p = 0.0012), and a history of cancer treatment (p = 0.0048) was identified as a significant source of heterogeneity for the 1-year OS. Radioembolization was associated with a lower incidence of grade 3/4 AEs than sorafenib (9% [95% CI, 3-27%] vs. 28% [95% CI, 17-43%]).
CONCLUSION
Compared with sorafenib, radioembolization is a safer and more effective treatment for HCC with PVTT and is associated with prolonged survival, delayed tumor progression, and fewer grade 3/4 AEs.

Keyword

Hepatocellular carcinoma; Portal vein tumor thrombosis; Radioembolization; Sorafenib; Meta-analysis

MeSH Terms

Carcinoma, Hepatocellular*
Humans
Incidence
Neoplasm Metastasis
Population Characteristics
Portal Vein*
Survival Rate
Thrombosis*

Figure

• 

  Fig. 1 Flowchart of publication selection process.PVTT = portal vein tumor thrombosis

• 

  Fig. 2 Forest plots of OS for (A) RE and (B) SOR.CI = confidence interval, OS = overall survival, RE = radioembolization, SOR = sorafenib

• 

  Fig. 3 Meta-analysis estimates of (A) OS and (B) KM rates according to TTP analysis across follow-up period.Error bars represent 95% CI. KM = Kaplan-Meier, TTP = time to progression

• 

  Fig. 4 Forest plots of KM rates according to TTP analysis for (A) RE and (B) SOR.

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