Transarterial Chemoembolization with DrugEluting Beads for Hepatocellular Carcinoma with Portal Vein Tumor Thrombus: a Single-Arm Systematic Review and Meta-Analysis

Introduction While drug-eluting transarterial chemoembolization (DEB-TACE) is gaining its own space as a reliable technique for treating hepatocellular carcinoma patients (HCC), it is still unclear how it may perform in more complex patients, such as in those whose tumor affects their portal circulation, resulting in portal vein tumor thrombosis (PVTT). Methods A comprehensive search was done on Pubmed, Embase, Cochrane Library, and Web of Science databases in order to find any clinical articles with more than 10 patients that evaluated the safety or efficacy of DEB-TACE for HCC patients with PVTT. Then, a meta-analysis was conducted to find the pooled estimates under the random effects model for tumor control, tumor worsening, post-embolization syndrome incidence and its symptoms, and mortality at different time points. Tumor control was defined as defined as the sum of complete response (CR), partial response (PR), and stable disease (SD) occurrences, based on the modified Response Evaluation Criteria in Solid Tumors (mRECIST), while tumor worsening was directly assessed through the occurrence of progressive disease (PD) as defined by the same criteria. Results 385 studies were initially found. Of these, 257 were unique entries. After title and abstract screening, 10 studies remained. Finally, per our exclusion and inclusion criteria, 8 articles were selected, amounting to 321 patients. A rate of 80% (95% CI: 70-91%; I² = 81%) was achieved for tumor control, with a congruent 17% rate (95% CI: 8-25%; I² = 72%) for tumor worsening. Only two studies reported post-embolization syndrome strictly, resulting in a high heterogeneity (I² = 97%), which resulted in a not very significant result (76%; 95% CI: 27-100%). In spite of this, incidence rates of 44% and 54% were found for nausea/vomits and fever, common symptoms of this syndrome. Moreover, death reports at one month were very low (0%; 95% CI: 0-2%, I² = 31%), while at six months they got up to a 22% rate (95% CI: 13-31%; I² = 39%), leading up to a 54% rate (95% CI: 46-63%; I² = 0%) at one year. Fig. 1: Tumor control Fig. 2: Tumor worsening Fig. 3: One-month mortality Fig. 4: One-year mortality Fig. 5: Six-month mortality Fig. 6: Post-embolization syndrome Conclusion DEB-TACE is an effective option for tumor control in HCC patients with PVTT, achieving a high rate of tumor control and a relatively low incidence of early mortality. However, the long-term prognosis remains challenging, with mortality rates increasing significantly over time. Post-embolization syndrome, although present, showed high variability in reporting. Further research is needed to better define DEB-TACE safety profile and long-term outcomes in this patient population.