Conventional Transarterial Chemoembolization Versus Drug-Eluting Beads in Patients with Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

SIMPLE SUMMARY: Hepatocellular carcinoma (HCC) is the most common type of liver cancer and accounts for approximately 6% of all human cancers. In this study, we performed a systematic review and pooled analysis of the conventional transcatheter arterial chemoembolization (C-TACE) compared to drug-eluting beads TACE (DEB-TACE) as two treatment options for patients with unresectable HCC. Treatment with DEB-TACE appears to be non-inferior compared to conventional C-TACE and associated with a better objective response and disease control with fewer severe complications and all-cause mortality. In light of these findings, research efforts should attempt to further characterize the efficacy and safety profile of DEB-TACE as a potential component of unresectable HCC management. ABSTRACT: Hepatocellular carcinoma (HCC) occurs in nearly three-quarters of all primary liver cancers, with the majority not amenable to curative therapies. We therefore aimed to re-evaluate the safety, efficacy, and survival benefits of treating patients with drug-eluting beads transcatheter arterial chemoembolization (DEB-TACE) compared to the conventional transcatheter arterial chemoembolization (C-TACE). Several databases were searched with a strict eligibility criterion for studies reporting on adult patients with unresectable or recurrent HCC. The pooled analysis included 34 studies involving 4841 HCC patients with a median follow-up of 1.5 to 18 months. There were no significant differences between DEB-TACE and C-TACE with regard to complete response, partial response and disease stability. However, disease control (OR: 1.42 (95% CI (1.03,1.96) and objective response (OR: 1.33 (95% CI (0.99, 1.79) were significantly more effective for DEB-TACE treatment with fewer severe complications and all-cause mortality. The pooled-analysis did not find superiority of DEB-TACE in complete or partial response, disease stability, controlling disease progression, and 30 day or end-mortality. However, results showed that DEB-TACE is associated with a better objective response, disease control, and lower all-cause mortality with severe complications compared to C-TACE treatment. Given that the safety outcomes are based on limited studies with a potential for bias, there was no clear improvement of DEB-TACE over C-TACE treatment.