Systematic review: evidence-based management of hepatocellular carcinoma – an updated analysis of randomized controlled trials
Article first published online: 12 MAY 2006
Alimentary Pharmacology & Therapeutics
Volume 23, Issue 11, pages 1535–1547, June 2006
How to Cite
LOPEZ, P. M., VILLANUEVA, A. and LLOVET, J. M. (2006), Systematic review: evidence-based management of hepatocellular carcinoma – an updated analysis of randomized controlled trials. Alimentary Pharmacology & Therapeutics, 23: 1535–1547. doi: 10.1111/j.1365-2036.2006.02932.x
- Issue published online: 12 MAY 2006
- Article first published online: 12 MAY 2006
- Publication data Submitted 27 February 2006 First decision 10 March 2006 Resubmitted 16 March 2006 Accepted 16 March 2006
The treatment strategy of hepatocellular carcinoma applied following scientific guidelines is only supported by 77 randomized controlled trials published so far, a figure that clearly pinpoints hepatocellular carcinoma as an ‘orphan’ cancer in terms of clinical research when compared with other high-prevalent cancers worldwide.
A systematic review analysing 61 randomized controlled trials (1978–2002) showed a modest survival benefit from chemoembolization in patients with intermediate tumours, and the lack of an effective first-line treatment option for patients with advanced disease. These conclusions have been endorsed by the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases.
The present updated evidence-based approach includes 16 randomized controlled trials published from 2002 to 2005 assessing percutaneous ablation (seven), other loco-regional therapies (three) and systemic therapies (six). Eight showed high-quality methodological profiles.
Four randomized controlled trials demonstrated a better local hepatocellular carcinoma control in tumours larger than 2 cm treated by radiofrequency ablation compared with ethanol injection. No survival advantages were obtained from systemic treatments in patients with advanced hepatocellular carcinoma, an area that is an unmet need. Therefore, there is an urgent request to conduct well-designed phase III investigations in hepatocellular carcinoma patients.