Efficacy and safety of boosted transarterial radioembolization in patients with chemoembolization-refractory...

BackgroundRepeated transarterial chemoembolization (TACE) may lead to treatment refractoriness, in which tumors fail to respond despite technically adequate procedures. However, evidence to guide optimal management strategies for patients with TACE-refractory hepatocellular carcinoma (HCC) remains limited.PurposeTo assess the efficacy and safety of boosted transarterial radioembolization (TARE) in patients with TACE-refractory HCC.Material and MethodsA total of 41 consecutive patients with TACE-refractory HCC underwent boosted TARE between November 2021 and December 2025. Tumor response, time to local tumor progression (TTLTP), time to progression (TTP), overall survival (OS), and adverse events were retrospectively analyzed.ResultsIn total, 41 patients (36 men; mean age=66.1 ± 9.3 years) were evaluated. The median number of prior TACE sessions was 4 (range=2-11). Best index tumor response was complete response in 31 (75.6%) patients, partial response in 6 (14.6%), and stable disease in 3 (7.3%), yielding an objective response rate of 90.2%. Median TTLTP was not reached at the time of analysis. Median TTP was 6.5 months (95% confidence interval [CI]=3.1-8.8). Median OS was 31.8 months (95% CI=19.4-not reached). Among 25 patients with disease beyond the Milan criteria, 20 (80.0%) were successfully downstaged to within the Milan criteria, of whom seven subsequently underwent curative-intent surgery. Longer OS was observed in surgical patients compared with non-surgical patients (P = .048). Severe adverse events occurred in 4 (9.8%) patients. One patient died from sepsis after tumor rupture.ConclusionBoosted TARE may provide favorable local tumor control in selected patients with TACE-refractory HCC. Careful patient selection and dosimetry remain essential.