Intervention Review

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Transarterial (chemo)embolisation versus no intervention or placebo intervention for liver metastases

  1. Robert P Riemsma1,*,
  2. Malgorzata M Bala2,
  3. Robert Wolff1,
  4. Jos Kleijnen3

Editorial Group: Cochrane Hepato-Biliary Group

Published Online: 30 APR 2013

Assessed as up-to-date: 11 MAR 2013

DOI: 10.1002/14651858.CD009498.pub3


How to Cite

Riemsma RP, Bala MM, Wolff R, Kleijnen J. Transarterial (chemo)embolisation versus no intervention or placebo intervention for liver metastases. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD009498. DOI: 10.1002/14651858.CD009498.pub3.

Author Information

  1. 1

    Kleijnen Systematic Reviews Ltd, York, UK

  2. 2

    Jagiellonian University Medical College, 2nd Department of Internal Medicine, Krakow, Poland

  3. 3

    School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, Netherlands

*Robert P Riemsma, Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business Park, Riccall Road, Escrick, York, YO19 6FD, UK. rob@systematic-reviews.com.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 30 APR 2013

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Characteristics of included studies [ordered by study ID]
Hunt 1990

MethodsStudy type: randomised clinical trial with three arms.
Location: UK.
Inclusion criteria:
• Patients with unresectable colorectal liver metastases. The diagnosis was confirmed by histological assessment or by combination of imaging procedures.


ParticipantsTotal number of patients: 61 patients, with 22 receiving embolisation, 19 hepatic artery infusion chemotherapy, and 20 control.


InterventionsTwo relevant treatment groups:
• Group 1: hepatic artery embolisation (n = 22).
• Group 2: control (n = 20).


OutcomesSurvival time and number of deaths, recurrence (extrahepatic disease) and adverse events.


NotesThe trial included a third group which was not used in this review (19 patients received hepatic artery infusion chemotherapy).


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear risk"20 were randomised to the control arm, 22 to ..."

Allocation concealment (selection bias)Unclear riskNot reported.

Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskNot reported.

Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskNot reported.

Incomplete outcome data (attrition bias)
All outcomes
Low riskNo missing outcome data were reported.

Selective reporting (reporting bias)High riskLocal recurrence was reported for 10 patients in the trial without details about the trial groups. Adverse events in the control group were not reported.

Other biasUnclear riskNot reported.

 
Summary of findings for the main comparison. Transarterial (chemo)embolisation compared to no intervention or placebo intervention for liver metastases

Transarterial (chemo)embolisation compared to no intervention or placebo intervention for liver metastases

Patient or population: liver metastases.
Settings: hospitalised.
Intervention: transarterial (chemo)embolisation.
Comparison: no intervention or placebo intervention.

OutcomesIllustrative comparative risks* (95% CI)Relative effect
(95% CI)
No of Participants
(studies)
Quality of the evidence
(GRADE)
Comments

Assumed riskCorresponding risk

No intervention or placebo interventionTransarterial (chemo)embolisation

Mortality
Participsants alive at last follow-up in percentage.
Follow-up: median 7 months.
Study populationRR 0.91
(0.75 to 1.1)1
42
(1 trial)
⊕⊝⊝⊝
very low2,3

950 per 1000865 per 1000
(712 to 1000)

Moderate


Time to mortality
Median survival after trial entry. Scale from: 1 to 44.
Follow-up: median 7 months.
The mean time to mortality in the control group was
7.9 months.
The mean time to mortality in the intervention group was
0.9 months lower
(0 to 0 higher)4
42
(1 trial)
⊕⊝⊝⊝
very low2,3

Extrahepatic disease
Number of patients developing evidence of extrahepatic disease.
Follow-up: median 7 months.
Study populationRR 1.64
(0.6 to 4.07)
42
(1 trial)
⊕⊝⊝⊝
very low2,3

250 per 1000410 per 1000
(150 to 1000)

Moderate


*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

 1 Our calculation, using the Mantel-Haenszel test in RevMan.
2 The trial did not describe sequence generation, allocation concealment or blinding, and the probability for selective outcome reporting bias in the trial is high.
3 Only 42 respondents were included in the two relevant intervention groups (I = 22, C = 20).
4 Median survival after trial entry was 7.0 months (range 2 to 44) in the intervention group and 7.9 months (range 1 to 26) in the control group. This difference was not statistically significant.