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To assess the effectiveness of I-125 seeds (IS) insertion with transcatheter arterial chemoembolization (TACE) in treating patients with advanced hepatocellular carcinoma (HCC). An extensive search was conducted for relevant randomized controlled trials (RCTs) from the establishment date of each database to November 2020. A total of nine RCTs were included in this study. Our analysis showed no significant changes in the pooled Δalpha-fetoprotein values  (p  = .06 ) , incident rates of myelosuppression ( p  = .46), vomit occurrence ( p  = .27), and abnormal liver function ( p  = .42) between the two treatment groups. However, the complete response ( p  &lt; .00001), total response ( p  &lt; .00001), and disease control ( p  &lt; .00001) rates were significantly higher in patients who underwent TACE with IS insertion, as opposed to patients who received TACE alone. Furthermore, patients who underwent TACE with IS insertion experienced markedly longer pooled overall survival (OS) time ( p  &lt; .0001), with better OS rates at the six-month ( p  = .0002), one-year ( p  &lt; .0001), and three-year ( p  = .0003) follow-ups than patients who received TACE alone. TACE with IS insertion can significantly improve clinical response and prolong the survival of advanced HCC patients.

I-125 seeds insertion with TACE for advanced HCC: a meta-analysis of randomized controlled trials