Transarterial radioembolization versus transarterial chemoembolization for tumor control and survival outcomes in early to intermediate stage hepatocellular carcinoma: systematic review and meta-analysis.

BACKGROUND: Transarterial radioembolization (TARE) is increasingly used as an alternate and potentially superior treatment option to Transarterial chemoembolization (TACE) for early- to intermediate-stage unresectable hepatocellular carcinoma (HCC). However, randomized controlled trials (RCTs) comparing the two modalities have reported mixed findings, and the comparative efficacy and safety remain uncertain. METHODS: A comprehensive literature search was conducted across five databases until August 2025, following PRISMA guidelines. Only RCTs comparing Yttrium-90 TARE (Y90-TARE) with TACE in adults with early- to intermediate-stage unresectable HCC were included. The primary outcomes were progression-free survival (PFS), overall survival (OS), and objective response rate (ORR). Secondary outcomes were adverse events, quality of life, and downstaging for liver transplantation. The quality of the evidence was assessed using the GRADE framework. RESULTS: Four RCTs comprising 169 patients (TARE = 87, TACE = 82) were included. No significant differences were observed in PFS (HR: 0.72, 95% CI: 0.43–1.20; P = 0.21), OS (HR: 0.82, 95% CI: 0.49–1.35; P = 0.43), ORR (OR: 1.32, 95% CI: 0.60–2.93; P = 0.49), and downstaging to liver transplantation (OR, 2.19; 95% CI, 0.85–5.66; P = 0.11). However, TARE was associated with significantly fewer treatment-related adverse events (OR, 0.38; 95% CI, 0.19–0.75; P = 0.005). The quality-of-life outcomes were comparable. CONCLUSION: Patients with early to intermediate stage HCC, treated with TARE and TACE, had similar survival outcomes. TARE appears to have a better safety profile with fewer treatment-related adverse events. The limitations of the current data suggest that prospective comparative studies including larger number of patients are needed.