Chemoembolization of hepatocellular carcinoma - What to tell the skeptics: Review and meta-analysis

Transcatheter arterial chemoembolization (TACE) has become the standard treatment for patients with unresectable hepatocellular carcinoma (HCC). When untreated, patients with inoperable HCC have a median survival of three months. Given the widespread use of chemoembolization, accurate evidence of the impact of TACE on patient survival is critical. Several review articles have examined randomized controlled trials (RCTs) of TACE; however, these analyses are inherently flawed by including trials in which control groups were treated. There have been only four RCTs comparing TACE to untreated controls to date. None has demonstrated a significant impact of TACE on patient survival. However, in addition to severe methodological flaws, these RCTs were limited by low patient enrollment, precluding any meaningful conclusions. In contrast, several non-randomized trials have clearly demonstrated a significant benefit of TACE on patient survival. New RCTs examining the impact of chemoembolization on survival are urgently needed to provide definitive evidence for the increasing number of patients treated with TACE. A new, well-designed RCT would provide significant insight on the impact of chemoembolization on patient survival.