Background/Aims: We previously demonstrated the safety and efficacy of low-dose, short-interval target vessel regional chemotherapy (TVRCLDSI) delivered through the hepatic artery with transarterial embolization (TAE) in patients with advanced gastric cancer (AGC). The present study aimed to compare the efficacy of TAE + TVRCLDSI with that of standard TAE + TVRC in AGC patients with liver metastases who failed to respond to first- or second-line systemic chemotherapy. Methods: This study recruited a total of 58 GC patients with liver metastases after failure of first- or second-line systemic chemotherapy. Twenty-eight patients were assigned to the TAE + TVRCLDSI group and 30 patients to the TAE + TVRC group. The primary end point was overall survival (OSTVRC), which was defined as the time from the initiation of TVRC until the last follow-up or death. Results: OSTVRC, time to progression (TTP) until appearance of intra- and extrahepatic metastases, and overall TTP and treatment periods in the TAE + TVRCLDSI group were all significantly longer than in the TAE + TVRC group (all p < 0.001). Conclusion: TAE + TVRCLDSI had a higher efficacy and safety, which was reflected by OS rates, progression-free survival rates, longer duration of treatment and milder side effects compared to standard TAE + TVRC.

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