Drug-eluting beads transarterial chemoembolization sequentially combined with radiofrequency ablation in the treatment of untreated and recurrent hepatocellular carcinoma

Abstract

BACKGROUND Drug-eluting beads transarterial chemoem-bolization (DEB-TACE) has the advantages of slow and steady release, high local concentration, and low incidence of adverse drug reactions compared to the traditional TACE. DEB-TACE combined with sequentially ultrasound-guided radiofrequency ablation (RFA) therapy has strong anti-cancer effects and little side effects, but there are fewer related long-term studies until now. AIM To explore the outcome of DEB-TACE sequentially combined with RFA for patients with primary hepatocellular carcinoma (HCC). METHODS Seventy-six patients with primary HCC who underwent DEB-TACE sequentially combined with RFA were recruited. Forty patients with untreated HCC were included in Group A, and 36 patients with recurrent HCC were included in Group B. In addition, 40 patients with untreated HCC who were treated with hepatectomy were included in Group C. The serological examination, preoperative magnetic resonance imaging examination, and post-treatment computed tomography enhanced examination were performed for all patients. The efficacy was graded as complete remission (CR), partial remission (PR), stable disease and progressive disease at the 3 rd , 6 th , and 9 th . All patients were followed up for 3 years and their overall survival (OS), disease-free survival (DFS) were assessed. RESULTS The efficacy of Group A and Group C was similar ( P > 0.05), but the alanine aminotransferase, aspartate aminotransferase and total bilirubin of Group A were lower than those of Group C (all P < 0.05). The proportions of CR (32.5%), PR (37.5%) were slightly higher than Group A (CR: 27.5%, PR: 35%), but the difference was not statistically significant ( χ 2 = 0.701, P = 0.873). No operational-related deaths occurred in Group A and Group C. The OS (97.5%, 84.7%, and 66.1%) and the DFS (75.0%, 51.7%, and 35.4%) of Group A at the 1 st , 2 nd , and 3 rd year after treatment were similar with those of Group C (OS: 90.0%, 79.7%, and 63.8%; DFS: 80.0%, 59.7%, and 48.6%; P > 0.05). The OS rates in Group A and Group B (90%, 82.3%, and 66.4%) were similar ( P > 0.05). The DFS rates in Group B (50%, 31.6%, and 17.2%) were lower than that of Group A ( P = 0.013). CONCLUSION The efficacy of DEA-TACE combined with RFA for untreated HCC is similar with hepatectomy. Patients with recurrent HCC could get a longer survival time through the combined treatment.

Chinese expert consensus on technical recommendations for the standard operation of drug-eluting beads for transvascular embolization

“…As we know, the treatment of liver cancer is a comprehensive treatment. In any studies, DEB-TACE combined with radiofrequency ablation or sorafenib get better effect compared with DEB-TACE alone in liver cancer (49,50). In the future, DEB-TACE combined other treatment like SIRT, immunotherapy will get better overall response rate and overall survival in HCC.…”

Combining local regional therapy and systemic therapy: Expected changes in the treatment landscape of recurrent hepatocellular carcinoma

“…A long-term follow-up observation of recurrent HCC with a diameter less than 5 cm showed that the 1-, 3-, and 5-year DFS rates after TACE combined with RFA treatment were 55.1%, 22.5%, and 9.7%, respectively, significantly higher than those after TACE treatment alone (41.1%, 9.9%, and 4.9%)[ 103 ]. A study of DEB-TACE combined with RFA for the treatment of recurrent HCC showed that the 1-, 2-, and 3-year OS rates were 90%, 82.3%, and 66.4%, respectively, percentages that were superior to those after surgical resection and RFA alone[ 104 ]. Compared with using RFA or TACE alone, combining the two methods has demonstrated advantages in the control of early and mid-stage recurrent HCC.…”

Radiological findings in non-surgical recurrent hepatocellular carcinoma: From locoregional treatments to immunotherapy

“…Zhang et al [ 46 ] demonstrated that DEB-TACE combined with RFA can increase the survival of patients with RHCC. Notably, OS rates were similar to primary HCC, while DFS rates were lower.…”