Comparative Efficacy and Safety of Transarterial Therapies for Unresectable Neuroendocrine Liver Metastases: A Systematic Review.
Hugo C Temperley, Richard Grainger, Omar Abu Saadeh et al.
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In 30 seconds
This systematic review compared transarterial embolisation, conventional and drug-eluting-bead chemoembolisation, and radioembolisation for adults with unresectable neuroendocrine liver metastases. It included 15 comparative studies with 1,454 patients, 12 of which were retrospective. No modality showed a consistent survival advantage. Safety pooling was possible for only two outcomes: post-embolisation syndrome with chemoembolisation versus embolisation (odds ratio 2.17, 95% confidence interval 0.68-7.00) and severe adverse events with chemoembolisation versus radioembolisation (odds ratio 1.27, 95% confidence interval 0.58-2.79).
Key findings
- No transarterial modality showed a consistent survival advantage across the comparative studies.
- Post-embolisation syndrome after chemoembolisation versus embolisation had an odds ratio of 2.17 (95% confidence interval 0.68-7.00), based on two studies.
- Severe adverse events after chemoembolisation versus radioembolisation had an odds ratio of 1.27 (95% confidence interval 0.58-2.79), based on two studies.
- Tumour grade and hepatic tumour burden were the most consistent prognostic factors; radioembolisation was associated with shorter hospital stays.
Why it matters
The review highlights that comparative evidence does not establish a survival advantage for any transarterial approach, while safety and other outcomes are reported inconsistently. Tumour biology and hepatic disease burden appear relevant to prognosis, and drug-eluting-bead chemoembolisation evidence remains limited amid hepatobiliary toxicity concerns. These findings frame treatment selection as a balance of disease features, goals, and safety rather than a choice supported by proven survival superiority.
What to keep in mind
Evidence was predominantly retrospective and heterogeneous, limiting pooled analysis; adjusted survival estimates with confidence intervals were reported in only four studies. The review states that the evidence is insufficient to establish equivalence.