Strategic integration of radioembolization and chemoembolization for the management of hepatocellular carcinoma in Korea

Transarterial chemoembolization (TACE) has long been the standard locoregional therapy for unresectable hepatocellular carcinoma, while transarterial radioembolization (TARE) using yttrium-90 microspheres has emerged as a promising alternative driven by advances in dosimetry and improved outcomes. TARE offers high complete response rates, durable local control, and minimal post-embolization syndrome, particularly in patients with localized or large tumors and preserved hepatic function. However, its broader use is limited by radiation-related toxicity, technical challenges, and socioeconomic factors, including high cost and limited repeatability. In contrast, TACE remains widely applicable, repeatable, and cost-effective, achieving excellent tumor control through refined superselective techniques, especially in Korea. Rather than competing modalities, TARE and TACE should be integrated within a tailored treatment strategy, with the choice determined by tumor characteristics, hepatic reserve, and institutional expertise.