Combined therapy with conventional trans-arterial chemoembolization (cTACE) and microwave ablation (MWA) for hepatocellular carcinoma >3–<5 cm

Abstract

Purpose: To compare safety and efficacy of combined therapy with conventional transarterial chemoembolization (cTACE)þmicrowave ablation (MWA) versus only TACE or MWA for treatment of hepatocellular carcinoma (HCC) >3-<5 cm. Methods: This randomized controlled trial (NCT04721470) screened 278 patients with HCC >3-<5 cm. Patients were randomized into three groups: 90 underwent TACE (Group 1); 95 underwent MWA (Group 2); and 93 underwent combined therapy (Group 3). Patients were followed-up with contrastenhanced CT or MRI. Images were evaluated and compared for treatment response and adverse events based on modified response evaluation criteria in solid tumor. Serum alpha-fetoprotein (AFP) concentration was measured at baseline and during every follow-up visit. Results: Final analysis included 265 patients (154 men, 111 women; mean age ¼ 54.5 ± 11.8 years; range ¼ 38-76 years). Complete response was achieved by 86.5% of patients who received combined therapy compared with 54.8% with only TACE and 56.5% with only MWA (p ¼ 0.0002). The recurrence rate after 12 months was significantly lower in Group 3 (22.47%) than Groups 1 (60.7%) and 2 (51.1%) (p ¼ 0.0001). The overall survival rate (three years after therapy) was significantly higher in Group 3 (69.6%) than Groups 1 (54.7%) and 2 (54.3%) (p ¼ 0.02). The mean progression-free survival was significantly higher in Group 3 than groups 1 and 2 (p < 0.001). A decrease in AFP concentration was seen in 75%, 63%, and 48% patients of Group 3, 2, and 1, respectively. Conclusions: Combined therapy with cTACE þ MWA is safe, well-tolerated, and more effective than TACE or MWA alone for treatment of HCC >3-<5 cm.

Chemoembolization Plus Microwave Ablation vs Chemoembolization Alone in Unresectable Hepatocellular Carcinoma Beyond the Milan Criteria: A Propensity Scoring Matching Study

“…25 MWA can effectively destroy some hypovascular HCC tumors that do not respond well to TACE treatment alone. [26][27][28][29] Another important finding of the study was that TACE following MWA may improve the downstaging rate significantly more than TACE alone. Liver transplantation is considered the standard therapy for HCC patients within MC, with a low recurrence rate (10%) and high 5-year survival rates (70%).…”

Hyperthermia ablation combined with transarterial chemoembolization versus monotherapy for hepatocellular carcinoma: A systematic review and meta‐analysis

“…Identification flow of the studies is exhibited as Figure 1 and Data . A total of 36 eligible studies 39–74 involving a large sample amount of 5036 patients were included finally for the systematic review and meta‐analysis (Figure 1, Table 1, Data ). All of the included studies 39–74 were published in SCI journals and included in the Web of Science with good quality of reports.…”

“…A total of 36 eligible studies 39–74 involving a large sample amount of 5036 patients were included finally for the systematic review and meta‐analysis (Figure 1, Table 1, Data ). All of the included studies 39–74 were published in SCI journals and included in the Web of Science with good quality of reports. The main features of the included trials 39–74 are detailedly presented in Table 1 and Data .…”

“…All of the included studies 39–74 were published in SCI journals and included in the Web of Science with good quality of reports. The main features of the included trials 39–74 are detailedly presented in Table 1 and Data .…”

Transarterial Chemoembolization for Hepatocellular Carcinoma: Why, When, How?

“…A randomized control trial by Zaitoun et al, comparing TACE or MWA monotherapy to combined treatment, concluded that combined therapy was safe, well-tolerated and more effective than TACE or MWA alone for treatment of HCC 3–5 cm. Those patients displayed lower recurrence rate after 12 months and significantly higher overall survival rate and mean progression-free survival [ 60 ]. A recent meta-analysis investigating the effectiveness of TACE + MWA versus TACE alone for unresectable BCLC stage A or B HCC < 5 cm showed that complete response, partial response, and objective response rates were significantly higher in TACE + MWA than those in TACE alone [ 61 ].…”