Selective Internal Radiotherapy vs Transarterial Chemoembolization for Unresectable Hepatocellular Carcinoma: A Systematic Review

Background Hepatocellular carcinoma (HCC) is the most common primary liver tumor, with transarterial chemoembolization (TACE) and selective internal radiotherapy (SIRT) as main therapeutic options for patients with intermediate-stage HCC. This review compares TACE and SIRT outcomes in unresectable HCC. Methods A literature search identified studies on HCC patients treated with TACE or SIRT. Quality was assessed using the Cochrane risk-of-bias 2 tool. Primary and secondary outcomes included overall survival (OS), time-to-progression (TTP), and progression-free survival (PFS). Results Ten studies met inclusion criteria, including a total of 1,386 patients (64% TACE, 36% SIRT). Overall quality of studies was high, with moderate risk of bias in one study. TACE showed longer weighted median OS (812 days, range 475-1119) than SIRT (280 days, range 268-840). TACE showed longer median PFS (254 days, range 216-265) than SIRT (151 days, range 125-359). SIRT showed a trend toward longer TTP with weighted median of 213 days (range 185-520) compared to 111 days (range 76-365) for TACE. Discussion SIRT may improve local tumor control, while TACE offers better OS and PFS in intermediate HCC. Given the heterogeneity across studies, further research is needed to define optimal treatment for unresectable HCC.