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Local Hepatic Therapies for Metastases to the Liver From Unresectable Colorectal Cancer
Comparative Effectiveness Reviews, No. 93
Investigators: Suzanne Belinson, MPH, PhD, Ryan Chopra, MPH, Yoojung Yang, MS, PharmD, Veena Shankaran, MD, and Naomi Aronson, PhD.
Author Information and AffiliationsStructured Abstract
Objectives:
To characterize the comparative effectiveness and harms of various local hepatic therapies for metastases to the liver from unresectable colorectal cancer (CRC) in two distinct populations: patients with liver-dominant metastases (i.e., majority of disease located in the liver) who are not eligible for continued systemic chemotherapy because their disease is refractory (i.e., they have experienced disease progression while on therapy), and patients who are candidates for local liver therapies as an adjunct to systemic chemotherapy. Local hepatic therapies include ablation, embolization, and radiotherapy approaches.
Data sources:
We searched MEDLINE® and Embase® from January 2000 to June 2012. We also searched for gray literature in databases with regulatory information, clinical trial registries, abstracts and conference papers, grants and federally funded research, and information from manufacturers.
Review methods:
We sought studies reporting two outcomes—overall survival and quality of life—and various adverse events related to the different interventions for the two populations of interest. Data were dually abstracted by a team of reviewers. A third reviewer resolved conflicts when necessary. We assessed the quality of individual studies and graded the strength of the body of evidence according to prespecified methods.
Results:
We identified 937 articles through the literature search and excluded 913 at various stages of screening; 24 articles were included in our review. We also included one hand-searched article from Annals of Oncology, two published articles from scientific information packets, and three articles identified from conference abstracts; the total number of articles was 30. Twenty-three articles addressed Key Questions (KQ) 1 (effectiveness) and 2 (harms) for patients ineligible for systemic chemotherapy, and seven addressed KQ3 (effectiveness) and KQ4 (harms) for patients who are candidates for systemic chemotherapy. One randomized controlled trial (RCT) was included but this was treated as a case-series because the comparator was not relevant to this comparative effectiveness review. All others articles were case series. Fifteen studies were of good quality, 12 studies were of fair quality, and 3 were rated as poor quality. No comparative studies met our inclusion criteria. Evidence was insufficient to determine the comparative effectiveness or harms of these interventions.
Conclusions:
In the absence of comparative data, the evidence is insufficient to permit conclusions on the comparative effectiveness of these therapies for unresectable CRC metastases to the liver. Gaps in the research base, even for critical benefits or harms, are extensive, and the quality of studies is generally questionable. Conducting RCTs (ideally head-to-head comparisons) to answer many important questions is desirable, but challenging.
Contents
- Preface
- Acknowledgments
- Key Informants
- Technical Expert Panel
- Peer Reviewers
- Executive Summary
- Introduction
- Methods
- Results
- Discussion
- References
- Appendix A Search Strategy
- Appendix B Contacted Authors
- Appendix C DistillerSR Screening and Abstraction Forms
- Appendix D Evidence Tables
- Appendix E Abbreviations and Acronyms
- Appendix F Excluded Studies
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. 290-2007-10058-I, Prepared by: Blue Cross and Blue Shield Association Technology Evaluation Center, Evidence-based Practice Center, Chicago, IL
Suggested citation:
Belinson S, Chopra R, Yang Y, Shankaran V, Aronson N. Local Hepatic Therapies for Metastases to the Liver From Unresectable Colorectal Cancer. Comparative Effectiveness Review No. 93. (Prepared by Blue Cross and Blue Cross Blue Shield Association Technology Evaluation Center under Contract No. 290-2007-10058-I.) AHRQ Publication No. 13-EHC014-EF. Rockville, MD: Agency for Healthcare Research and Quality. December 2012. www.effectivehealthcare.ahrq.gov/reports/final.cfm.
This report is based on research conducted by the Blue Cross Blue Shield Association Technology Evaluation Center (BCBSA TEC) Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA 290 2007 10058-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.
This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.
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540 Gaither Road, Rockville, MD 20850; www
.ahrq.gov
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