Table 37Summary of embolization treatment study and patient characteristics: case series studies

Study
N
Rating
Study DesignIntervention PeriodInterventionAge, Mean or Median (Range)ECOG ScoreCP
A%; B%; C%
BCLC
A%; B%
Previous LDT %
Bargellini et al. 201164
67
Fair
Prospective case series01/2006 - 03/2009TACE with lipiodol (mean: 16.1 mL, range: 10–25 mL), epirubicin hydrochloride (mean: 57 mg, range: 40–75 mg), and gelatin sponge particles via hepatic arteryMean: 70 (NR)NRA: 79.1;
B: 20.9;
C: 0
0: 13.6;
A: 88.1;
B: 0
NR
Buijs et al. 200865
190
Fair
Retrospective case series01/2002 - 01/2007TACE with cisplatin (100 mg), doxorubicin (50 mg), mitomycin C (10 mg) in a 1:1 mixture with iodized oil, and either polyvinyl alcohol particles or gelatin-coated trisacryl microspheres via femoral arteryMean: 65 (18–84)NRA: 66;
B: 34;
C: 0
NRNR
Carr et al. 200466
65
Poor
Prospective case series08/2000 - 08/2003RE with Y90 (dose delivered mean: 145.7 Gy, median: 134.3 Gy, range: 61.1–280.9Gy) via hepatic arteryMedian: 69 (NR)NRNRNRNR
Carr et al. 201067
99
Fair
Prospective cohort*2000 - 2005RE with Y90 (deliver 135–150 Gy) via hepatic artery over 1–5 minNRNRNRNRNR
Giannini et al. 201068
128
Poor
Retrospective cohort*2003 - 2006TACE with an emulsion of lipiodol and chemotherapeutic agent (doxorubicin, epirubicin, mitoxantrone)Median: 66 (NR)NRA: 64.8;
B: 35.2;
C: 0
NRNR
Guiu et al. 200969
43
Fair
Retrospective case series09/2000 - 12/2006TACE with pirarubicin (50 mg) diluted in 5% glucose (20 mL), lipiodol (20 mL), particles of gelatin sponge (2- to 3-mm diameter), and amiodarone (150 mg) via femoral artery once every 6–8 weeksMedian: 64.9 (47–86)NRA: 85;
B: 12.5;
C: 2.5
NRNR
Imai et al. 201170
122
Poor
Retrospective case series12/2007 - 12/2010TACE with miriplatin (median 80 mg, range 20–120 mg) and lipiodol (median 3 mL, range 1–6 mL) via hepatic arteryMedian: 72 (48–87)NRA: 75.4;
B: 24.6;
C: 0
NRTACE: 80
Kanhere et al. 200871
12
Poor
Prospective case series08/2000 - 02/2005RE with radiolabelled lipiodol (average dose 1.7GBq (1.4–2.2 GBq) diluted in unlabeled lipiodol (2–10 mL) via hepatic arteryMean: 63.4 (34–83)NRA: 75;
B: 25;
C: 0
NRNR
Kawaoka et al. 200972
107
Poor
Retrospective case series06/2000 - 12/2007TACE with lipiodol and cisplatin (total per case median: 60 mg, range 10–390 mg) with or without embolization via femoral arteryMedian: 73 (42–92)NRA: 72.1;
B: 27.9;
C: 2.8
NRNR
Kim et al. 201283
2
Poor
Case ReportTACE for 6 sessions in one case, unknown schedule in the other caseNRNRNRNRTACE: 50
Leelawat et al. 200873
15
Poor
Prospective cohort01/2007 - 12/2007TACE with doxorubicin (25–50 mg) plus mitomycin C (5–10 mg) in a mixture of ionized oil contrast medium and Ivalon particlesMedian: 59 (37–65)NRNRNRNR
Leelawat et al. 200873
15
Poor
Prospective cohort01/2007 - 12/2007TACE with mitomycin C (5–10 mg) in a mixture of ionized oil contrast medium and Ivalon particlesMedian: 52 (40–65)NRNRNRNR
Liu et al. 200474
11
Fair
Retrospective case series01/2002 - 08/2003RE with Y90 TheraSphere (prescribed dose 100–150 Gy) via hepatic arteryMedian: 67 (51–73)NRNRNRTACE: 36, TACE and resection: 18, TACE and RFA: 9, RFA 9
Mabed et al. 200975
50
Fair
RCT*09/2003 - 06/2005TACE using lipiodol (10 mg), doxorubicin (50 mg) and cisplatin (50 mg) via hepatic artery every 4 weeks as long as the condition permits and total dose of 500 mg/m2 not exceededMedian: 52 (36–60)0:26;
1-2:74
A: 68;
B: 32;
C: 0
NRNR
Maeda et al. 200876
33
Fair
Retrospective case series01/2000 - 03/2006TACE with iodized oil, epirubicin (accumulated dose average 16.1 mg, range 0–72.5 mg) and gelatin sponge via hepatic artery for an average of 2.3 sessions (range 1–7 sessions)Mean: 69.6 (38–85)NRA: 79;
B: 21;
C: 0
NRNR
Martin et al. 201177
118
Poor
Prospective case series01/2007 - 10/2009DEB with doxorubicin (75 mg per 2 mL, minimum recommended volume of 10 mL) in 2 bead vials via hepatic artery every 3–8 weeks for 2–4 treatment cyclesMedian: 68 (35–88)0 or 1: 91A: 72;
B: 28;
C: 0
NRNR
Molinari et al.78 2006
47
Poor
Prospective case series11/2001 - 05/2004TACE with doxorubicin (75 mg/m2) with lipiodol (10 mL) followed in some patients with polyvinyl alcohol particles via hepatic artery or superselectively in some casesMean: 63.4 (NR)NRNRNRRFA: 4.3
Pietrosi et al. 200949
320
Poor
Case series (uncertain if prospective or retrospective)01/2000 - 12/2004TACE with epirubicin (50 mg/m2) with or without iodized oil and/or Gelfoam via hepatic artery or transarterial embolization with iodized oil and/or Gelfoam via superselective artery supplying a single lesion or hepatic arteryMedian: 63 (35–81)NRA: 61.9;
B: 30.6;
C: 2.8
NRNR
Rand et al. 200579
46
Good
Retrospective case series01/2000 - 09/2002TAE with tirsacryl gelatin microspheres (size 100–700 μ) followed by cyanoacrylate (0.3–1 mL) and lipiodol via hepatic arteriesNRNRA: 45.7;
B: 23.9;
C: 8.7
NRNR
Reso et al. 200984
1
Poor
Case reportTACE with cisplatin (50 mg), adriamycin (50 mg) and lipidol (20 mL)NRNRNRNRNR
Seki et al. 201180
135
Poor
Retrospective case series05/2007 - 06/2009TACE with epirubicin-loaded (25–30 mg) superabsorbent polymer microspheres via hepatic arteryMean: 72 (31–87)NRA: 60.0;
B: 39.3;
C: 0.7
NRInterventional radiology: 86.7; TACE: 48.2
Wu et al. 201081
110
Poor
Retrospective cohort04/2008 - 04/2009TACE with I-metuximab-131 (median 1720 MBq, 95% CI, 1654–1804 MBq), epirubicin, lipiodol, and/or gelfoam sponge via transhepatic artery for 5–10 minMedian: 48 (25–84)0:100A: 69;
B: 31;
C: 0
NRNone: 72; RFA: 16
Wu et al. 201081
132
Poor
Retrospective cohort06/2008 - 12/2008TACE with epirubicin and lipiodol and/or gelfoam spongeMedian: 52 (24–89)0:100A: NR;
B: 35;
C: NR
NRNR
Zhang et al. 201182
277
Good
Prospective case series12/2003 - 11/2005TACE with 5-fluorouracil (1 g), cis-dichlorodiamine platinum (80 mg), mitomycin (10 mg) mixed with lipiodol (5–30 mL) and, for some patients, gelatin sponge, via hepatic artery repeated every 8–12 weeks until stabilization of the tumorMedian: 54 (12–85)NRA: 89.2;
B: 10.8;
C: 0
A: 0;
B: 100
NR
*

Only a single arm of the two comparative arms was included in this evidence review.

Abbreviations: BCLC = Barcelona Clinic Liver Center hepatocellular carcinoma stage; CI = confidence interval; CT = computed tomography; CP = Child-Pugh liver cirrhosis class; DEB = drug-eluting bead; ECOG = Eastern Cooperative Oncology Group; GBq = gigabecquerel; Gy = Gray; LDT = liver directed therapy; N = number of patients; NR = not reported; RCT = randomized controlled trial; RE = radioembolization; SD = standard deviation; TACE = transarterial chemoembolization; TAE = transarterial embolization; US = ultrasound; Y90 = yittrium-90.

From: Results

Cover of Local Therapies for Unresectable Primary Hepatocellular Carcinoma
Local Therapies for Unresectable Primary Hepatocellular Carcinoma [Internet].
Comparative Effectiveness Reviews, No. 114.
Belinson S, Yang Y, Chopra R, et al.

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