Radiation Therapy Found More Effective Than TACE for Liver Cancer

What Is the Best Treatment for Early-stage Liver Cancer?

Hepatocellular carcinoma (HCC)is the most common liver cancer worldwide, and identifying the best treatment is particularly important in early and intermediate stages. Transarterial chemoembolization (TACE) is an established treatment used for many years. A new meta-analysis, however, found that external-beam radiation therapy (conventional radiation delivered from outside the body)was superior to TACE in local control and progression-free survival outcomes.

TACEis a minimally invasive liver cancer treatment. Chemotherapy is delivered into the tumor through the hepatic artery, which is then embolized to cut off tumor blood flow and allow the medication to act directly on it.

This important study was published online on January 30, 2025, in Cancer and led by Ryan A. Kuehnle of the University of Texas Health Science Center. Findings suggest radiation could be an effective first-line treatment for patients with hepatocellular carcinoma.

Meta-analysis Details

Although TACE is considered standard for intermediate-stage hepatocellular carcinoma, radiation has attracted interest as a noninvasive alternative. Researchers performed a meta-analysis of randomized controlled trials comparing the clinical effectiveness of radiation and TACE in early and intermediate disease.

• Three trials were included: one multicenter and two single-center studies.
• Together, they enrolled 142 patients who were initially unsuitable for resection or liver transplantation and needed definitive treatment or tumor reduction before transplantation.
• The main outcomes were:
  • Local tumor control
  • Overall survival
  • Progression-free survival
  • Frequency of serious (Grade ≥ 3) adverse events

Results

The advantages of radiation compared with TACE were:

• Local control was significantly better with radiation. At 1 year, local control was 85% with radiation versus 35% with TACE; at 2 years, 83% versus 20%; and at 3 years, 62% versus 11% (HR: 0.16).
• Progression-free survival also favored radiation. At 1 year, rates were 56% with radiation versus 32% with TACE; at 2 years, 40% versus 32%; and at 3 years, 37% versus 7% (HR: 0.37).
• Overall survival was numerically better with radiation, but the difference was not statistically significant. At 1 year, survival was 83% with radiation versus 79% with TACE; at 3 years, 44% versus 35% (RR: 0.79; 95% CI, 0.51-1.22).
• Adverse effects showed no significant difference in Grade ≥ 3 toxicity between treatments (RR: 0.86; 95% CI, 0.31-2.37). However, total adverse-event counts were lower with radiation, 13 cases versus 21 with TACE. Gastrointestinal and hepatobiliary problems were most common and occurred more often in the TACE group.

Role in Clinical Practice

Compared with TACE, radiation provides better local control and progression-free survival with similar overall survival. It should therefore be considered a first-line option as a standalone local liver cancer treatment.

Limitations

The meta-analysis has several limitations:

• Including only published studies may introduce publication bias.
• Only three trials were available, with relatively few patients.
• Recruitment difficulties may have increased selection bias.

Conclusions and Commentary

This meta-analysis shows better local control and progression-free survival with radiation than with TACE in hepatocellular carcinoma. Therefore, radiation in patients unsuitable for surgeryshould be considered a strong first-line alternative. Larger randomized controlled trials are nevertheless needed to confirm these findings.