REVIEW ARTICLE - OVERVIEW OF MEDICAL TREATMENTS IN UNRESECTABLE HEPATOCELLULAR-CARCINOMA - AN IMPOSSIBLE METAANALYSIS

Background: Controversies surrounding medical treatment in patients wi th unresectable hepatocellular carcinoma continue to persist. Aim: To perform a meta-analysis of therapeutic modalities which had been evalu ated in two or more randomized trials. Methods: Fifty-two randomized t rials were studied; only 30 were included, This overview identified se ven therapeutic modalities which had been evaluated in two or more tri als: adriamycin, 5-fluorouracil, interferon, percutaneous ethanol inje ction, transarterial chemotherapy, the combination of lipiodol with tr ansarterial chemotherapy, and tamoxifen, Results: Comparisons of survi val between control groups showed substantial heterogeneity. There was no sur vival benefit at 1 year with adriamycin (mean difference 4%), 5-fluorouracil (mean difference -3%), percutaneous ethanol injection ( mean difference 6%) or transarterial chemotherapy (mean difference -2% ), For interferon, the survival benefit was significant with the Der S imonian & Laird method (mean difference 9%, 95% CI = 1-18%, P = 0.04) but not with the Peto tit al, method (2.4 mean odds ratio, 95% CI = 0. 9-6.8), The meta-analysis of tamoxifen showed a borderline survival be nefit (mean difference 25%, 95% CI = 0-49%, P = 0.05). However, in sen sitivity analyses, the survival benefit of tamoxifen was no longer sig nificant, Conclusions: No treatment has clearly proven efficacy in sur vival, 5-Fluorouracil, adriamycin and transarterial chemotherapy were not associated with survival benefit at 1 year. The number of randomiz ed controlled trials was insufficient to enable a conclusion to be rea ched for interferon and percutaneous ethanol injection. Controversy pe rsists concerning tamoxifen efficacy, Interferon and tamoxifen require new randomized controlled trials on a larger population of patients.