Table 5. Comparison between SIRT and TKIs or TACE, respectively.
| Population | Both used as a noncurative treatment for HCC patients with BCLC stage B-C | Wider patient pool; Suitable for patients with more advanced liver disease, multifocal disease, vascular invasion, and PVTT [97] |
| Intervention | SIRT | SIRT |
| Comparator | TKI | TACE |
| Outcome | SIRT compared with other modalities | |
| Safety and Side effects | Side effects less common [84,85] | Better toxicity profile [97], less PES [110]; Less post-treatment pain, more subjective fatigue, no difference in nausea, vomiting, fever, or other complications [107] |
| Adverse events/complications | Less common [111], less grade 3/4 adverse events requiring dose modifications or interruptions | Less adverse events [96,108,112] |
| OS, PFS | No significant difference [84,85,111,113,114] | No significant difference in OS [108,109,115]; OS and PFS at 1-year: No significant difference [109]; Better 2- and 3-year OS (vs. cTACE), more inferior 2-year OS (vs. DEB-TACE) [112] |
| TTP | No significant difference [111,114] | Longer [110] median TTP (>26 months vs. 7 months) [115]; No significant difference [116] |
| Response | Higher ORR [84] | EASL: No significant difference [115]; Response rate (CR, PR): No significant difference [107]; Better ORR [96] |
| Bridging | SIRT allows for bridging to curative treatment | Bridging for transplantation: Greater tumor shrinkage [117], higher proportion proceed to transplant [109], higher response [99] |
| Other considerations | More significant cost savings (5.4–24.9%) [118] | Shorter hospitalization, can perform outpatient [110] Fewer treatment sessions [109,110], higher pre-treatment cost [119], less cost-effective in BCLC Stage A-B but more cost-effective in BCLC-C [119]; Quality of life: FACT-Hep scores similar [120] but better performance in sub-features of quality of life [121] |
CR: Complete response; EASL: European Association for the Study of the Liver; FACT-Hep: Functional Assessment of Cancer Therapy-Hepatobiliary; ORR: Objective response rates; OS: Overall Survival; PFS: Progression-free survival; PES: Post-embolization syndrome; PR: Partial response; PVTT: Portal vein tumor thrombus; SIRT: Selective internal radiation therapy; TACE: tranSarterial chemoembolization; TKI: Tyrosine kinase inhibitors; TTP: time To progression; WHO: World Health Organization