Transarterial Radioembolization Versus Chemoembolization for Unresectable Large Single Hepatocellular Carcinoma
In brief
Large liver cancers: radioembolization linked to 26 months longer survival
In this single-center retrospective study of unresectable solitary liver cancers at least 6 cm, adjusted median survival was 79.6 months with radioembolization versus 53.4 months with chemoembolization. Radioembolization was also associated with better local tumor control and fewer serious adverse events, but patient selection, including eligibility based on lung shunting, may explain some of the survival difference.
- Journal
- Korean journal of radiology (Q1)
- Published
- 1 October 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Myungsu Lee, Minuk Kim, Jayoun Kim, Do Hoon Kim, Jin Wook Chung, Hyo-Cheol Kim
- PMID
- 42849888
- DOI
- 10.3348/kjr.2026.0458
Why clinicians should know about it
- Picked for Radiology, Radiation Oncology, Nuclear Medicine, Medical Physics and Imaging (paper of the day, 10 October 2026): TARE vs TACE for large HCC, interventional radiology outcomes
Abstract
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.