S2617 Comparative Efficacy and Safety of Yttrium-90 Glass vs Resin-Based Microspheres in Hepatocellular Carcinoma Treatment: A Systematic Review and Meta-Analysis

Introduction: Hepatocellular carcinoma (HCC), a leading cause of cancer mortality, is frequently unresectable. Transarterial radioembolization (TARE), a minimally invasive catheter-based procedure, delivers Yttrium-90 (⁹⁰Y) microspheres intra-arterially to irradiate tumours selectively while sparing healthy liver. Glass (TheraSphere) and resin (SIR-Spheres) based microspheres are used, but comparative outcomes remain debated. This systematic review and meta-analysis evaluates the efficacy and safety of glass versus resin microspheres for HCC in clinical practice. Methods: A systematic search was conducted through PubMed, Embase, Web of Science, and ClinicalTrials.gov from inception to April 2025 using keywords to identify relevant studies. Case reports, commentaries, non-human research, duplicates, and studies lacking data on glass or resin-based spheres were excluded. The primary endpoints were overall survival (OS), objective response rate (ORR), and disease control rate (DCR). Secondary outcomes included laboratory and clinical toxicities. Random-effects meta-analysis was conducted with Review Manager 5.4 to pool data and calculate risk ratios (RR) and mean difference (MD). A leave-one-out sensitivity analysis was done to assess the effects of individual studies on the overall result. Results: Five studies with 460 patients (252 glass, 208 resin) were analyzed – 2 retrospective non-randomized trials and 3 retrospective cohort studies. The population included 376 men (81.7%) with mean or median ages ranging from 60 to 69 years. No significant difference was observed in OS (MD 3.42, 95% CI, -2.42 to 9.26; P = 0.25), ORR (RR 0.94, 95% CI, 0.68 to 1.28; P = 0.68) and DCR (RR 0.97, 95% CI, 0.88 to 1.07; P = 0.56) between the 2 groups. Glass microspheres exhibited similar laboratory (bilirubin, albumin and aspartate/alanine transaminase) and clinical (pain, nausea, fatigue and anorexia) toxicities compared to resin microspheres. Sensitivity analysis favored glass microspheres with improved OS (MD 6.62, 95% CI, 4.81 to 8.42; P < 0.01, I² = 0%) and ORR (RR 0.88, 95% CI, 0.77 to 1.00; P = 0.05, I² = 0%). Conclusion: Glass and resin microspheres exhibit comparable efficacy and safety for the treatment of HCC. Sensitivity analysis suggests potential OS and ORR advantages with glass microspheres, warranting validation in larger randomized trials to optimize microsphere selection in specific subpopulations.