Comparative Efficacy and Safety of Transarterial Therapies for Unresectable Neuroendocrine Liver Metastases: A...

To compare the efficacy and safety of transarterial embolisation, conventional and drug-eluting-bead chemoembolisation, and radioembolisation in adults with unresectable neuroendocrine liver metastases.

Five databases were searched from inception to June 2026 for studies comparing two or more transarterial modalities. Study quality was appraised using the Newcastle-Ottawa Scale or the Cochrane Risk of Bias 2 tool. Because outcome reporting was heterogeneous, findings were synthesised narratively; pooling was undertaken only where two or more studies reported per-arm binary event counts.

Fifteen comparative studies including 1,454 patients were identified, 12 of them retrospective. Pooling was feasible for two safety outcomes only, each drawing on two studies: post-embolisation syndrome after chemoembolisation versus embolisation (odds ratio 2.17, 95% confidence interval 0.68-7.00) and severe adverse events after chemoembolisation versus radioembolisation (odds ratio 1.27, 95% confidence interval 0.58-2.79). Adjusted survival estimates with confidence intervals were reported in only four studies. Tumour grade and hepatic tumour burden were the most consistent prognostic factors. No modality showed a consistent survival advantage; radioembolisation offered shorter hospital stays, and evidence for drug-eluting-bead chemoembolisation remained limited amid hepatobiliary toxicity concerns.

No transarterial modality has been shown to confer a consistent survival advantage, but the evidence is predominantly retrospective and too heterogeneous to establish equivalence. Selection should be individualised within a multidisciplinary team, accounting for disease burden, tumour biology, treatment goals, and safety. Adequately powered prospective trials remain an unmet priority.