TARE Improves Outcomes Versus TACE for Large Unresectable HCC
Key Clinical Summary
- In a retrospective study of 306 patients with solitary unresectable hepatocellular carcinoma (HCC) ≥6 cm, transarterial radioembolization (TARE) was associated with longer adjusted overall survival and local progression-free survival than transarterial chemoembolization (TACE).
- Serious adverse events occurred in 10.1% with TARE vs 26.7% with TACE, and prolonged hospitalization occurred in 0.8% vs 22.5%, respectively.
- Investigators caution that lung-shunt-related patient selection may have contributed to the observed survival advantage.
Transarterial radioembolization (TARE) was associated with longer overall survival (OS), improved local tumor control, and fewer serious adverse events than transarterial chemoembolization (TACE) among patients with large, solitary unresectable hepatocellular carcinoma (HCC). Authored by Lee and colleagues from the Seoul National University Hospital, the study was published on September 14, 2026, in the Korean Journal of Radiology.1
Study Findings
The single-center retrospective study included 306 adults with solitary HCC of at least 6 cm who received TACE (n=187) or TARE (n=119) as initial treatment between January 2010 and December 2023. Additional criteria were that the patients had an Eastern Cooperative Oncology Group performance status of less than or equal to 1, a Child-Pugh score of A or B7, and were without vascular invasion or extrahepatic metastasis. The primary endpoint was OS; secondary endpoints included progression-free survival (PFS), local PFS, tumor response, and safety.
After applying inverse probability of treatment weighting to address baseline differences, median OS was 79.6 months with TARE vs 53.4 months with TACE (P = .033); median local PFS was 25.1 vs 9.5 months, respectively (P = .001). Median overall PFS was also numerically longer with TARE (9.8 vs 7.8 months), but the difference was not statistically significant.
TARE was also associated with fewer serious adverse events (10.1% vs 26.7%; P < .01) and less hospitalization exceeding 7 days (0.8% vs 22.5%; P < .01).
Clinical Implications
Importantly, the investigators caution against attributing the OS difference solely to treatment. Among patients assigned to TACE, 39 had originally been considered for TARE but were ineligible because of high estimated lung dose related to lung shunting; this subgroup had a median OS of only 20.3 months. These results, together with previous findings, suggest that high lung shunt fraction may be indicative of more aggressive tumor biology—therefore, treatment-selection bias should not be discounted when interpreting the comparisons between TARE and TACE in this study.
The authors concluded that TARE was associated with longer survival, improved local tumor control, and fewer serious adverse events in this population, while emphasizing that lung-shunt-related biological selection may have contributed to the survival difference.
Reference
- Lee M, Kim M, Kim J, et al. Transarterial radioembolization versus chemoembolization for unresectable large single hepatocellular carcinoma. Korean J Radiol. 2026;27:e93. doi:10.3348/kjr.2026.0458
