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BACKGROUND: The authors evaluated and compared the treatment outcomes of transarterial chemoembolization (TACE) between young (≤70 years) and elderly (>70 years) patients at their institute over an 18-year period. METHODS: Advanced hepatocellular carcinoma (HCC) patients who received TACE at the authors' center were analyzed retrospectively. The demographic data, TACE-related morbidities, and survival outcome were compared between these 2 age groups. RESULTS: Between 1989 and 2006, 843 patients who were ≤70 years old and 197 patients who were >70 years old received TACE treatment for advanced HCC. There were significantly more comorbid illnesses associated with the elderly patients than the young patients (64 % vs 33%, P < .01). Moreover, elderly patients who received TACE treatment for HCC were at earlier stages of disease (P < .01). Both the overall median survival (14.0 months vs 8.1 months, P < .003) and disease-specific survival (15.2 months vs 8.7 months, P < .001) were significantly higher in elderly than young patients. The most commonly encountered TACE-related morbidity in both age groups was liver function derangement. Young patients had a significantly higher rate of developing liver derangement after TACE than elderly patients (21% vs 11%, P < .01). Conversely, the elderly patients had a significantly higher rate of developing peptic ulcer disease with TACE treatment than young patients (2.5% vs 0.5%, P = .01). Overall, there was no significant difference in TACE-related mortality between the young and elderly patients (3% vs 4%, P = .49). CONCLUSIONS: This study has confirmed the comparable efficacy and tolerability in using TACE for the treatment of advanced HCC in young and elderly patient populations. Cancer 2009. © 2009 American Cancer Society.