Cancers, Vol. 17, Pages 2254: Transarterial Chemoembolization Outperforms Radioembolization in Early- and Intermediate-Stage Hepatocellular Carcinoma: A Multicenter Retrospective Study

Cancers doi: 10.3390/cancers17132254

Authors:
Faisal M. Sanai
Adnan Alzanbagi
Mohammed Arabi
Sarah S. Alfawaz
Khalid I. Bzeizi
Mohammed Almatrafi
Abdulmalik M. Alsabban
Jameel Bardesi
Hamdan S. Alghamdi
Mohamed Shawkat
Talal M. Alotaibi
Khairat H. Alameer
Shadi Saleem
Saad Abualganam
Abdulaziz M. Tashkandi
Noha H. Guzaiz
Nesreen H. Abourokbah
Hassan O. Alfakieh
Majed Almaghrabi
Abeer A. Alabdullah
Lujain H. Aljohani
Nuwayyir A. Alqasimi
Saad Aldosari
Azzam Khankan
Dieter Broering
Saleh A. Alqahtani

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.

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Faisal M. Sanai www.mdpi.com