Summary (10 sec read)

The incidence of Hepatocellular Carcinoma (HCC) has been increasing, with traditional treatment often involving Transarterial Chemoembolization (TACE). However, Transarterial Radioembolization (TARE) is gaining prominence for treating unresectable HCC due to its potential advantages. Studies demonstrate TARE's overall survival benefit, improved quality of life, and better toxicity profile compared to TACE. TARE's smaller particles make it suitable for patients with advanced liver disease, multifocal disease, vascular invasion, and portal vein thrombosis, reducing ischemia and necrosis risks seen with TACE.

TARE is also associated with a lower risk of post-embolization syndrome and is generally better tolerated, unlike TACE, which often causes liver function deterioration, pain, and fever. For early-stage HCC patients who are not candidates for radiofrequency ablation, TARE provides better response rates, tumor control, and survival outcomes. In Neuroendocrine Tumor (NET) patients with multiple liver lesions or tumors lacking somatostatin receptors, TARE is preferred over TACE.

Despite TARE's higher initial cost, its overall cost-effectiveness is superior due to fewer hospital admissions, reduced pain management needs, and lower treatment multiplicity and toxicity. TARE thus offers significant benefits for advanced liver disease, presenting a favorable side-effects profile and better cost-efficiency compared to TACE.

The incidence of Hepatocellular Carcinoma or HCC has been increasing over the past several years and several studies have projected that the incidence of HCC will continue to rise in the coming years.

Transarterial Chemoembolisation or TACE has been the initial treatment modality for HCC and has a huge body of evidence from several studies and clinical trials. Therefore, for long TACE has been a preferred treatment algorithm for unresectable HCC.

However, as the experience of Transarterial Radioembolisation or TARE has evolved, it is playing an increasingly important role in the treatment of unresectable HCC. Studies and trials have shown that TARE has many potential advantages over TACE and there is now substantial evidence to favor TARE over TACE.

The many potential advantages of TARE when compared with TACE are as below:

  • Several studies have shown a statistically significant overall survival advantage with TARE as compared to TACE.
  • TARE has better health-related quality-of-life metrics and toxicity profile when compared with TACE.
  • TARE as a much wider range of applications, including use in patients with more advanced liver disease, multi-focal disease, vascular invasion and portal vein thrombosis. Actually, TARE is more suitable for patients of HCC with portal vein thrombosis because of the small size of TARE particles when compared with TACE, which tends to induce more ischemia and necrosis.
  • Studies have also shown a much-lower risk of post-embolisation syndrome with TARE as compared with TACE.
  • In terms of side-effects, TARE is overall well-tolerated, whereas post-TACE, there is deterioration of the liver function coupled with pain and fever.
  • In patients with early-stage HCC and preserved liver function who are not candidates for radiofrequency ablation, TARE provides better response rates, tumor control and survival outcomes.
  • In Neuroendocrine Tumor (NET) patients with multiple lesions in both the lobes of the liver, TARE is a preferred modality and TACE is not recommended at all.
  • Also, in NET patients where the tumor does not express somatostatin receptors, TARE is a much better treatment technique as compared to TACE.
  • When it comes to cost, the upfront cost of a single TARE session is much higher (at least two to three times higher) than the cost of a single TACE session. However, considering the cost of hospital admission, pain control, treatment multiplicity and toxicity, the overall cost-effectiveness of TARE is likely to be superior to TACE in patients with unresectable HCC.  

In terms of overall survival and delay of progression in patients with unresectable HCC, TARE is as efficacious as TACE, however TARE has an evolving role to play in the treatment of HCC with more advanced liver disease, multi-focal disease, vascular invasion and portal vein thrombosis. Apart from these reasons, a more favorable side-effects profile and cost are the other potential advantages of TARE as compared to TACE.

In terms of overall survival and delay of progression in patients with unresectable HCC, TARE is as efficacious as TACE, however TARE has an evolving role to play in the treatment of HCC with more advanced liver

disease, multi-focal disease, vascular invasion and portal vein thrombosis. Apart from these reasons, a more favorable side-effects profile and cost are the other potential advantages of TARE as compared to TACE.