Transarterial Chemoembolization Outperforms Radioembolization in Early- and Intermediate-Stage Hepatocellular...

Area of Science:

• Hepatobiliary oncology
• Interventional radiology
• Medical physics

Background:

• Transarterial radioembolization (TARE) using Yttrium-90 microspheres is a standard treatment for unresectable hepatocellular carcinoma (HCC).
• The comparative clinical effectiveness of TARE versus transarterial chemoembolization (TACE) for HCC requires further clarification.

Purpose of the Study:

• To compare the efficacy and safety of TARE and TACE in patients with unresectable HCC.
• To evaluate survival outcomes, including overall survival and response rates, between TARE and TACE treatments.

Main Methods:

• Retrospective analysis of 279 patients with unresectable HCC treated with either TARE (n=104) or TACE (n=175) at four tertiary centers.
• Exclusion criteria included metastatic disease, locally advanced HCC, and Child-Pugh C liver dysfunction.
• Data collected encompassed treatment details, adverse events, overall survival (mOS), and objective response rates (mRECIST).

Main Results:

• The TARE cohort had larger maximum tumor diameters compared to the TACE cohort (4.4 cm vs. 3.1 cm, p < 0.001).
• Transarterial chemoembolization (TACE) was associated with longer median overall survival (mOS) (37 vs. 22 months; HR 1.65, p = 0.002), particularly in early-stage BCLC 0/A patients (60 vs. 25 months; HR 2.35, p = 0.016).
• Hepatic decompensation occurred more frequently after TARE (26.0%) than TACE (13.7%, p = 0.010).

Conclusions:

• Transarterial chemoembolization (TACE) demonstrates superior survival outcomes compared to transarterial radioembolization (TARE) for unresectable hepatocellular carcinoma (HCC).
• These findings suggest that TACE may be a more effective treatment option, especially for early-stage HCC.
• A more individualized approach to selecting embolization therapies based on patient and disease characteristics is warranted.