CT-guided High-Dose-Rate Brachytherapy versus Transarterial Chemoembolization in Patients with Unresectable Hepatocellular Carcinoma

Published Online:https://doi.org/10.1148/radiol.232044

In treatment-naive patients with unresectable hepatocellular carcinoma, CT-guided high-dose-rate brachytherapy led to improved survival outcomes compared with transarterial chemoembolization.


CT-guided high-dose-rate (HDR) brachytherapy (hereafter, HDR brachytherapy) has been shown to be safe and effective for patients with unresectable hepatocellular carcinoma (HCC), but studies comparing this therapy with other local-regional therapies are scarce.


To compare patient outcomes of HDR brachytherapy and transarterial chemoembolization (TACE) in patients with unresectable HCC.

Materials and Methods

This multi-institutional retrospective study included consecutive treatment-naive adult patients with unresectable HCC who underwent either HDR brachytherapy or TACE between January 2010 and December 2022. Overall survival (OS) and progression-free survival (PFS) were compared between patients matched for clinical and tumor characteristics by propensity score matching. Not all patients who underwent TACE had PFS available; thus, a different set of patients was used for PFS and OS analysis for this treatment. Hazard ratios (HRs) were calculated from Kaplan-Meier survival curves.


After propensity matching, 150 patients who underwent HDR brachytherapy (median age, 71 years [IQR, 63–77 years]; 117 males) and 150 patients who underwent TACE (OS analysis median age, 70 years [IQR, 63–77 years]; 119 male; PFS analysis median age, 68 years [IQR: 63–76 years]; 119 male) were analyzed. Hazard of death was higher in the TACE versus HDR brachytherapy group (HR, 4.04; P < .001). Median estimated PFS was 32.8 months (95% CI: 12.5, 58.7) in the HDR brachytherapy group and 11.6 months (95% CI: 4.9, 22.7) in the TACE group. Hazard of disease progression was higher in the TACE versus HDR brachytherapy group (HR, 2.23; P < .001).


In selected treatment-naive patients with unresectable HCC, treatment with CT-guided HDR brachytherapy led to improved OS and PFS compared with TACE.

© RSNA, 2024

Supplemental material is available for this article.

See also the editorial by Chapiro in this issue.


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Article History

Received: Aug 11 2023
Revision requested: Oct 11 2023
Revision received: Nov 15 2023
Accepted: Dec 18 2023
Published online: Feb 06 2024