TACEt the rainbow.

Treatment options for unresectable hepatocellular carcinoma (HCC) come in every flavor. We recently confirmed that selective internal radiation therapy (SIRT) adds little more than toxicity. So how does stereotactic body radiation (SBRT) stack up to the more established transarterial chemoembolization (TACE)? Well, it’s hard to say since we don’t have results from a randomized trial. At least there’s now a large retrospective comparison of prospectively collected cohorts. There are the usual caveats, including that most in the SBRT failed previous ablation or TACE. Nonetheless, two-year local control per RECIST criteria among the 114 tumors in the TACE cohort was 23%, the stark loser when compared to the reported 91% control rate among 173 tumors treated with SBRT. Not to mention double the grade 3+ toxicity rate following TACE. The arguably more important endpoint of total liver control at 2 years is less promising: 11% with TACE versus 27% with SBRT, highlighting that transplant really is the only curative option. Despite the caveats, this at least supports moving on to SBRT sooner rather than later after a TACE failure and at most may mean SBRT will supplant TACE altogether.