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To assess the efficacy and safety of transarterial chemoembolization (TACE) and portal vein radioactive seed insertion (RSI) combination in hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). The relevant databases were searched from the earliest to January 2021. The endpoints included treatment response, treatment side effects, and overall survival (OS). Nine studies were included in this meta-analysis. The pooled total response (TR,  p  = 0.55) and disease control (DC,  p  = 0.13) rates for HCC were similar between the two treatment groups. The pooled TR ( p  = 0.0004) and DC ( p  &lt; 0.0001) rates for PVTT were both significantly higher in the TACE with portal vein RSI group than in the TACE without portal vein RSI group. The pooled HR for OS was significantly better in the TACE with portal vein RSI group than in the TACE without portal vein RSI group ( p  &lt; 0.00001). The pooled rates of fever ( p  = 0.97), vomiting ( p  = 0.64), and myelosuppression ( p  = 0.65) were similar between the two groups. Compared to traditional TACE, TACE combined with portal vein RSI can effectively prolong the patients’ OS and decrease PVTT disease progression.

TACE with portal vein radioactive seeds for HCC with portal vein tumor thrombus: a meta-analysis