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Updated: Oct 10, 2026
Transradial Access Chemoembolization for Hepatocellular Carcinoma Patients
Published on: September 20, 2020
Transarterial Radioembolization Versus Chemoembolization for Unresectable Large Single Hepatocellular Carcinoma
Myungsu Lee1, Minuk Kim1, Jayoun Kim2
1Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Objective:
To compare oncologic outcomes and safety between transarterial radioembolization (TARE) and transarterial chemoembolization (TACE) in patients with unresectable large solitary hepatocellular carcinomas (HCCs; ≥6 cm).
Materials And Methods:
This single-center retrospective study included patients with a solitary HCC ≥6 cm who underwent initial treatment with TARE or TACE between January 2010 and December 2023. Patients who were initially scheduled to undergo TARE but were subsequently treated with TACE because of a high lung shunt fraction (LSF) were included in the TACE group. The primary outcome was overall survival (OS), and secondary outcomes included progression-free survival (PFS), local PFS, tumor response, and safety. Inverse probability of treatment weighting (IPTW) was used to adjust for baseline differences in the survival analyses.
Results:
In total, 306 patients were included in this study (TACE, n = 187; TARE, n = 119). Before IPTW adjustment, the TARE group demonstrated significantly longer OS than the TACE group (median, 79.6 vs. 46.5 months; P = 0.004). Patients who were ineligible for TARE because of extensive lung shunting demonstrated particularly poor survival (median OS, 20.3 months). After IPTW adjustment, TARE remained associated with longer OS (median, 79.6 vs. 53.4 months; P = 0.033) and local PFS (median, 25.1 vs. 9.5 months; P = 0.001). Median PFS remained numerically longer with TARE (9.8 vs. 7.8 months), but the difference did not reach statistical significance (P = 0.066). In comparison with TACE, TARE was associated with less frequent serious adverse events (10.1% vs. 26.7%; P < 0.01) and a markedly lower rate of prolonged hospitalization (>7 days) (0.8% vs. 22.5%; P < 0.01).
Conclusion:
In patients with unresectable large solitary HCCs, TARE was associated with longer OS, improved local tumor control, and fewer serious adverse events than TACE. However, the survival advantage should be interpreted with caution, because biological selection related to LSF eligibility may have contributed to the observed difference.
