Background: Drug-eluting bead transarterial chemoembolization (DEB-TACE) and yttrium-90 ( 90 Y) 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 90 Y standard dosimetry (<200 Gy), which produced inferior outcomes compared with modern-day 90 Y personalized dosimetry, which yields tumor doses exceeding 205 Gy. Purpose: This study utilized PSM between DEB-TACE and 90 Y 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 90 Y as the initial treatment approach from 2015 to 2024. PSM was performed ( 90 Y: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, 90 Y 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 90 Y (68% vs. 13%). 90 Y 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 90 Y, although overall TPP and OS were similar between treatment modalities. In multifocal disease, 90 Y generated superior response rates as well as target ( p =0.007) and overall TTP ( p =0.015). Conclusions: 90 Y with personalized dosimetry achieved higher response rates and extended the duration of complete responses compared with DEB-TACE. 90 Y was also more effective at treating multifocal disease.
Núñez et al. (Fri,) studied this question.