Comparative Effectiveness of Hepatic Artery Based Therapies for Unresectable Colorectal Liver Metastases: A Meta-Analysis.
<h4>Background</h4>Patients with unresectable Colorectal Liver Metastases (CRLM) are increasingly being managed using Hepatic Artery Based Therapies (HAT), including Hepatic Arterial Infusion (HAI), Radioembolization (RE), and Transcatheter Arterial Chemoembolization (TACE). Limited data...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2015-01-01
|
| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0139940&type=printable |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849723569661018112 |
|---|---|
| author | Anthony J Zacharias Thejus T Jayakrishnan Rahul Rajeev William S Rilling James P Thomas Ben George Fabian M Johnston T Clark Gamblin Kiran K Turaga |
| author_facet | Anthony J Zacharias Thejus T Jayakrishnan Rahul Rajeev William S Rilling James P Thomas Ben George Fabian M Johnston T Clark Gamblin Kiran K Turaga |
| author_sort | Anthony J Zacharias |
| collection | DOAJ |
| description | <h4>Background</h4>Patients with unresectable Colorectal Liver Metastases (CRLM) are increasingly being managed using Hepatic Artery Based Therapies (HAT), including Hepatic Arterial Infusion (HAI), Radioembolization (RE), and Transcatheter Arterial Chemoembolization (TACE). Limited data is available on the comparative effectiveness of these options. We hypothesized that outcomes in terms of survival and toxicity were equivalent across the three strategies.<h4>Methods</h4>A meta-analysis was performed using a prospectively registered search strategy at PROSPERO (CRD42013003861) that utilized studies from PubMed (2003-2013). Primary outcome was median overall survival (OS). Secondary outcomes were treatment toxicity, tumor response, and conversion of the tumor to resectable. Additional covariates included prior or concurrent systemic therapy.<h4>Results</h4>Of 491 studies screened, 90 were selected for analyses-52 (n = 3,000 patients) HAI, 24 (n = 1,268) RE, 14 (n = 1,038) TACE. The median OS (95% CI) for patients receiving HAT in the first-line were RE 29.4 vs. HAI 21.4 vs. TACE 15.2 months (p = 0.97, 0.69 respectively). For patients failing at least one line of prior systemic therapy, the survival outcomes were TACE 21.3 (20.6-22.4) months vs. HAI 13.2 (12.2-14.2) months vs. RE 10.7 (9.5-12.0). Grade 3-4 toxicity for HAT alone was 40% in the HAI group, 19% in the RE group, and 18% in the TACE groups, which was increased with the addition of systemic chemotherapy. Level 1 evidence was available in 5 studies for HAI, 2 studies for RE and 1 for TACE.<h4>Conclusion</h4>HAI, RE, and TACE are equally effective in patients with unresectable CRLM with marginal differences in survival. |
| format | Article |
| id | doaj-art-b3bbd03b9d55475ead21b1caf9b507f4 |
| institution | DOAJ |
| issn | 1932-6203 |
| language | English |
| publishDate | 2015-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj-art-b3bbd03b9d55475ead21b1caf9b507f42025-08-20T03:10:59ZengPublic Library of Science (PLoS)PLoS ONE1932-62032015-01-011010e013994010.1371/journal.pone.0139940Comparative Effectiveness of Hepatic Artery Based Therapies for Unresectable Colorectal Liver Metastases: A Meta-Analysis.Anthony J ZachariasThejus T JayakrishnanRahul RajeevWilliam S RillingJames P ThomasBen GeorgeFabian M JohnstonT Clark GamblinKiran K Turaga<h4>Background</h4>Patients with unresectable Colorectal Liver Metastases (CRLM) are increasingly being managed using Hepatic Artery Based Therapies (HAT), including Hepatic Arterial Infusion (HAI), Radioembolization (RE), and Transcatheter Arterial Chemoembolization (TACE). Limited data is available on the comparative effectiveness of these options. We hypothesized that outcomes in terms of survival and toxicity were equivalent across the three strategies.<h4>Methods</h4>A meta-analysis was performed using a prospectively registered search strategy at PROSPERO (CRD42013003861) that utilized studies from PubMed (2003-2013). Primary outcome was median overall survival (OS). Secondary outcomes were treatment toxicity, tumor response, and conversion of the tumor to resectable. Additional covariates included prior or concurrent systemic therapy.<h4>Results</h4>Of 491 studies screened, 90 were selected for analyses-52 (n = 3,000 patients) HAI, 24 (n = 1,268) RE, 14 (n = 1,038) TACE. The median OS (95% CI) for patients receiving HAT in the first-line were RE 29.4 vs. HAI 21.4 vs. TACE 15.2 months (p = 0.97, 0.69 respectively). For patients failing at least one line of prior systemic therapy, the survival outcomes were TACE 21.3 (20.6-22.4) months vs. HAI 13.2 (12.2-14.2) months vs. RE 10.7 (9.5-12.0). Grade 3-4 toxicity for HAT alone was 40% in the HAI group, 19% in the RE group, and 18% in the TACE groups, which was increased with the addition of systemic chemotherapy. Level 1 evidence was available in 5 studies for HAI, 2 studies for RE and 1 for TACE.<h4>Conclusion</h4>HAI, RE, and TACE are equally effective in patients with unresectable CRLM with marginal differences in survival.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0139940&type=printable |
| spellingShingle | Anthony J Zacharias Thejus T Jayakrishnan Rahul Rajeev William S Rilling James P Thomas Ben George Fabian M Johnston T Clark Gamblin Kiran K Turaga Comparative Effectiveness of Hepatic Artery Based Therapies for Unresectable Colorectal Liver Metastases: A Meta-Analysis. PLoS ONE |
| title | Comparative Effectiveness of Hepatic Artery Based Therapies for Unresectable Colorectal Liver Metastases: A Meta-Analysis. |
| title_full | Comparative Effectiveness of Hepatic Artery Based Therapies for Unresectable Colorectal Liver Metastases: A Meta-Analysis. |
| title_fullStr | Comparative Effectiveness of Hepatic Artery Based Therapies for Unresectable Colorectal Liver Metastases: A Meta-Analysis. |
| title_full_unstemmed | Comparative Effectiveness of Hepatic Artery Based Therapies for Unresectable Colorectal Liver Metastases: A Meta-Analysis. |
| title_short | Comparative Effectiveness of Hepatic Artery Based Therapies for Unresectable Colorectal Liver Metastases: A Meta-Analysis. |
| title_sort | comparative effectiveness of hepatic artery based therapies for unresectable colorectal liver metastases a meta analysis |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0139940&type=printable |
| work_keys_str_mv | AT anthonyjzacharias comparativeeffectivenessofhepaticarterybasedtherapiesforunresectablecolorectallivermetastasesametaanalysis AT thejustjayakrishnan comparativeeffectivenessofhepaticarterybasedtherapiesforunresectablecolorectallivermetastasesametaanalysis AT rahulrajeev comparativeeffectivenessofhepaticarterybasedtherapiesforunresectablecolorectallivermetastasesametaanalysis AT williamsrilling comparativeeffectivenessofhepaticarterybasedtherapiesforunresectablecolorectallivermetastasesametaanalysis AT jamespthomas comparativeeffectivenessofhepaticarterybasedtherapiesforunresectablecolorectallivermetastasesametaanalysis AT bengeorge comparativeeffectivenessofhepaticarterybasedtherapiesforunresectablecolorectallivermetastasesametaanalysis AT fabianmjohnston comparativeeffectivenessofhepaticarterybasedtherapiesforunresectablecolorectallivermetastasesametaanalysis AT tclarkgamblin comparativeeffectivenessofhepaticarterybasedtherapiesforunresectablecolorectallivermetastasesametaanalysis AT kirankturaga comparativeeffectivenessofhepaticarterybasedtherapiesforunresectablecolorectallivermetastasesametaanalysis |