Radioembolization (Y90) achieves higher response rates and reduces progression risk compared with DEB-TACE in hepatocellular carcinoma

BACKGROUND: Drug-eluting bead transarterial chemoembolization (DEB-TACE) and yttrium-90 (90Y) radioembolization are approved therapies to treat hepatocellular carcinoma (HCC). Several randomized controlled trials and propensity score-matched studies (PSM) have been conducted to compare these 2 treatments; many utilized 90Y standard dosimetry (<200 Gy), which produced inferior outcomes compared with modern-day 90Y personalized dosimetry, which yields tumor doses exceeding 205 Gy. PURPOSE: This study utilized PSM between DEB-TACE and 90Y with personalized dosimetry to compare treatment and patient outcomes in Barcelona Clinic Liver Cancer (BCLC) A-B HCC. METHODS: This retrospective study included 258 patients with unresectable BCLC A-B stage HCC treated with DEB-TACE or 90Y as the initial treatment approach from 2015 to 2024. PSM was performed (90Y:DEB-TACE), matching for tumor burden and alpha-fetoprotein levels at diagnosis. The primary endpoint was target response rate with secondary endpoints of overall response, target retreatment rate (TTR), target and overall time-to-progression (TTP), and overall survival (OS). RESULTS: Overall, 90Y achieved significantly higher target complete (CR) and objective response (OR) rates compared with DEB-TACE (71% vs. 33% and 88% vs. 58%), respectively. In multifocal disease, target CR rates were higher following 90Y (68% vs. 13%). 90Y also yielded a longer duration of CR with a 1-year target retreatment rate of 12% compared with 40% with DEB-TACE. This translated into a longer target TPP (p=0.030) with 90Y, although overall TPP and OS were similar between treatment modalities. In multifocal disease, 90Y generated superior response rates as well as target (p=0.007) and overall TTP (p=0.015). CONCLUSIONS: 90Y with personalized dosimetry achieved higher response rates and extended the duration of complete responses compared with DEB-TACE. 90Y was also more effective at treating multifocal disease.