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. 2025 Jul 7;17(13):2254.
doi: 10.3390/cancers17132254.

Transarterial Chemoembolization Outperforms Radioembolization in Early- and Intermediate-Stage Hepatocellular Carcinoma: A Multicenter Retrospective Study

Faisal M Sanai  1   2 , Adnan Alzanbagi  3 , Mohammed Arabi  4 , Sarah S Alfawaz  1 , Khalid I Bzeizi  5 , Mohammed Almatrafi  1 , Abdulmalik M Alsabban  1 , Jameel Bardesi  6   7 , Hamdan S Alghamdi  8 , Mohamed Shawkat  9 , Talal M Alotaibi  4 , Khairat H Alameer  4 , Shadi Saleem  10 , Saad Abualganam  10 , Abdulaziz M Tashkandi  3 , Noha H Guzaiz  11 , Nesreen H Abourokbah  6 , Hassan O Alfakieh  1 , Majed Almaghrabi  1   12 , Abeer A Alabdullah  13 , Lujain H Aljohani  14 , Nuwayyir A Alqasimi  14 , Saad Aldosari  1 , Azzam Khankan  6 , Dieter Broering  5 , Saleh A Alqahtani  5   13   15
Affiliations

Transarterial Chemoembolization Outperforms Radioembolization in Early- and Intermediate-Stage Hepatocellular Carcinoma: A Multicenter Retrospective Study

Faisal M Sanai et al. Cancers (Basel). .

Abstract

Background: Transarterial radioembolization (TARE) with Yttrium-90 microspheres is an established therapy for unresectable hepatocellular carcinoma (HCC). However, its clinical efficacy compared to transarterial chemoembolization (TACE) remains unclear. Methods: We retrospectively reviewed 279 consecutive patients undergoing TARE (n = 104) or TACE (n = 175) at four tertiary centers. Patients with metastatic disease, locally advanced HCC, or Child-Pugh (CP) C were excluded. Data on treatment, adverse events, survival outcomes (median overall survival [mOS], and objective response rates [by modified Response Evaluation Criteria in Solid Tumors; mRECIST]) were collected. Results: The median follow-up of the cohort was 27 months (IQR 13-50), the mean age was 67.6 ± 10.1 years, and 207 (74.2%) were male. The cohort was balanced in age, performance status, CP class, and HCC etiology. Maximum tumor diameter was significantly larger in the TARE cohort compared to the TACE cohort (4.4 vs. 3.1 cm, p < 0.001), including within the BCLC 0/A (4.2 vs. 2.7 cm, p = 0.001) and BCLC B (5.0 vs. 4.0 cm, p = 0.049) subgroups. The mOS was longer with TACE (37 vs. 22 months; hazard ratio [HR] 1.65, 95% CI: 1.19-2.29, p = 0.002). In BCLC 0/A patients, TACE yielded longer mOS (60 vs. 25 months; HR 2.35, 95% CI: 1.17-4.69; p = 0.016). In BCLC B, mOS was longer with TACE (32 vs. 20 months), but was not statistically significant (HR 1.39, 95% CI: 0.96-2.03, p = 0.080). In BCLC 0/A, complete response rates were higher with TACE (43.2% vs. 34.3%, p = 0.012). Hepatic decompensation was more frequent with TARE- (26.0%) than with TACE-treated patients (13.7%, p = 0.010). Conclusions: TACE demonstrated superior survival outcomes over TARE, particularly in early-stage disease. These results advocate for a more nuanced selection of embolization therapies in these patients.

Keywords: BCLC; Y90; decompensation; disease control; hepatocellular carcinoma; locoregional therapy; response; survival; transarterial chemoembolization; transarterial radioembolization; treatment.

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Conflict of interest statement

Dr. Sanai consults for, and is on the speakers’ bureau of, Boston Scientific, Roche Pharmaceuticals, AstraZeneca, and Bayer-Schering. Others have nothing to disclose. Drs. Arabi and Khankan consult for, and are on the speakers’ bureau of Boston Scientific and Sirtex. Dr. Alzanbagi is on the speakers’ bureau of Boston Scientific and AstraZeneca.

Figures

Figure 1
Figure 1
Survival analysis of patients undergoing transarterial chemoembolization and radioembolization.
Figure 2
Figure 2
Survival analysis of patients undergoing transarterial chemoembolization and radioembolization in sub-groups of (A) BCLC 0/A and (B) BCLC B.
See this image and copyright information in PMC

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