title: Efficacy and safety of transarterial radioembolization versus chemoembolization in patients with hepatocellular carcinoma.
abstract: OBJECTIVE
  Intermediate-stage hepatocellular carcinoma (HCC) is usually treated with locoregional therapy using transarterial chemoembolization (TACE). Transarterial radioembolization (TARE) using β-emitting yttrium-90 integral to the glass matrix of the microspheres is an alternative to TACE. This retrospective case-control study compared the outcomes and safety of TARE versus TACE in patients with unresectable HCC.
  
  
  METHODS
  Patients with unresectable HCC without portal vein thrombosis treated with TARE between 2005 and 2008 (n = 61) were retrospectively frequency-matched by age, sex, and liver dysfunction with TACE-treated patients (n = 55) in the Mayo Clinic Hepatobiliary Neoplasia Registry. Imaging studies were reviewed, and clinical and safety outcomes were abstracted from the medical records.
  
  
  RESULTS
  Complete tumor response was more common after TARE (12 %) than after TACE (4 %) (p = 0.17). When complete response was combined with partial response and stable disease, there was no difference between TARE and TACE. Median survival did not differ between the two groups (15.0 months for TARE and 14.4 months for TACE; p = 0.47). Two-year survival rates were 30 % for TARE and 24 % for TACE. TARE patients received fewer treatments (p < 0.001). Fifty-nine (97 %) TARE patients received outpatient treatment. In contrast, 53 (98 %) TACE patients were hospitalized for ≥1 day (p < 0.001). Compared with TACE, TARE was more likely to induce fatigue (p = 0.003) but less likely to cause fever (p = 0.02).
  
  
  CONCLUSIONS
  There was no significant difference in efficacy between TARE and TACE. TARE patients reported more fatigue but had less fever than TACE patients. Treatment with TARE required less hospitalization than treatment with TACE. These findings require confirmation in randomized trials.
authors.affiliation: Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. morenoluna.laura@gmail.com
authors.forename: Laura E
authors.initials: LE
authors.lastname: Moreno-Luna
authors.forename: Ju Dong
authors.initials: JD
authors.lastname: Yang
authors.forename: William
authors.initials: W
authors.lastname: Sanchez
authors.forename: Ricardo
authors.initials: R
authors.lastname: Paz-Fumagalli
authors.forename: Denise M
authors.initials: DM
authors.lastname: Harnois
authors.forename: Teresa A
authors.initials: TA
authors.lastname: Mettler
authors.forename: Denise N
authors.initials: DN
authors.lastname: Gansen
authors.forename: Piet C
authors.initials: PC
authors.lastname: de Groen
authors.forename: Konstantinos N
authors.initials: KN
authors.lastname: Lazaridis
authors.forename: K V
authors.initials: KV
authors.lastname: Narayanan Menon
authors.forename: Nicholas F
authors.initials: NF
authors.lastname: Larusso
authors.forename: Steven R
authors.initials: SR
authors.lastname: Alberts
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Gores
authors.forename: Chad J
authors.initials: CJ
authors.lastname: Fleming
authors.forename: Seth W
authors.initials: SW
authors.lastname: Slettedahl
authors.forename: William S
authors.initials: WS
authors.lastname: Harmsen
authors.forename: Terry M
authors.initials: TM
authors.lastname: Therneau
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Wiseman
authors.forename: James C
authors.initials: JC
authors.lastname: Andrews
authors.forename: Lewis R
authors.initials: LR
authors.lastname: Roberts
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000628:therapy*; D016022:Case-Control Studies; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000008:administration & dosage*
chemical_list: D015021:Yttrium Radioisotopes