Large primary hepatocellular carcinoma: Transarterial chemoembolization monotherapy versus combined transarterial chemoembolization‐percutaneous microwave coagulation therapy

Xu, Li; Sun, Hongzan; Chen, Yaoting; Ni, Jingxian; Chen, Dong; Luo, Jun; Zhou, Jian; R, Hu; Tan, Qi-Yun

doi:10.1111/jgh.12088

Cited by 68 publications

(48 citation statements)

References 32 publications

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“…Previously, two retrospective studies demonstrated the superior treatment effectiveness of the TACE-MWA combination therapy compared with the TACE monotherapy for specific HCC patients (7,8). However, their studies did not specify the BCLC stage and included HCC patients at BCLC stages A, B, and C. Our study focused mainly on BCLC stage B patients with tumor size ≤7 cm and tumor number ≤5.…”

Section: Discussionmentioning

confidence: 99%

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Combined transarterial chemoembolization and microwave ablation versus transarterial chemoembolization in BCLC stage B hepatocellular carcinoma

Zhang¹,

Shen

Zhao

et al. 2018

Diagn Interv Radiol

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Section: Discussionmentioning

confidence: 99%

“…therapy of TACE and MWA led to better outcome than TACE monotherapy for specific HCC patients (7,8), but their studies did not specify the BCLC stage of included patients. Currently, no clinical guideline clearly defines the indication of combination therapy in BCLC stage B patients.…”

mentioning

confidence: 99%

Combined transarterial chemoembolization and microwave ablation versus transarterial chemoembolization in BCLC stage B hepatocellular carcinoma

Zhang¹,

Shen

Zhao

et al. 2018

Diagn Interv Radiol

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“…Given that MWA can create a larger ablation zone, MWA alone or combined with TACE has increasingly been used in treating large HCC [76,77,78]. Abdelaziz et al [78] recently performed a study to compare the efficacy and safety of percutaneous MWA with TACE for large tumors (5-7 cm) and demonstrated better results for MWA than TACE in managing large HCC lesions.…”

Section: Local Ablative Therapymentioning

confidence: 99%

“…Abdelaziz et al [78] recently performed a study to compare the efficacy and safety of percutaneous MWA with TACE for large tumors (5-7 cm) and demonstrated better results for MWA than TACE in managing large HCC lesions. Another retrospective study [77] compared the outcomes of TACE combined with MWA (TACE-MWA) with TACE for treating unresectable large HCC (≥5.0 cm in diameter). The results showed that TACE-MWA had advantages in prolonging OS, with satisfying times to progression and improving liver function.…”

Section: Local Ablative Therapymentioning

confidence: 99%

A Recent Advance in Image-Guided Locoregional Therapy for Hepatocellular Carcinoma

Shi

Zhai

2016

Gastrointest Tumors

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Background: Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the third most common cause of cancer-related deaths. Hepatic resection and liver transplantation are considered to be the preferred treatment for HCC. However, as novel therapeutic options such as image-guided locoregional therapies have emerged and been refined, the manner in which HCC is treated has changed dramatically compared with what it was considered just 2 decades earlier. Summary: This study reviews the current results of various image-guided locoregional therapies for treating HCC, especially focusing on thermal ablative and transarterial techniques. Key Message: Advances in image-guided locoregional therapies, including local ablative therapy and transarterial therapy, have led to a major breakthrough in the management of HCC. Both survival rates and cure rates of patients with HCC have improved markedly since the introduction of these techniques. Practical Implications: Radiofrequency ablation is currently considered as an alternative to surgical resection for patients with early-stage HCC. A newer technique of ablation such as microwave ablation is increasingly being used, especially for large HCC. Transarterial chemoembolization has become a standard care for asymptomatic patients with multinodular tumors in intermediate-stage disease, and transarterial radioembolization has become the method of choice in HCC cases with portal vein thrombosis. Moreover, combination treatment modalities, such as thermal-based ablation combined with transarterial chemoembolization or ¹²⁵I seed implant brachytherapy, may further broaden their clinical indications for HCC. Moreover, use of localized radiation in combination with thermal ablation has been reported to improve tumor control and long-term survival.

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“…Compared with single treatment regimen, the combination therapy yielded improved results regarding complete necrosis rate, tumor growth reduction and overall survival (9,10). However, the effect of microwave ablation after TACE on the hypoxic cells and subsequent vascular endothelial growth factor (VEGF) production is unclear.…”

Section: Resultsmentioning

confidence: 99%

Study on the effect of chemoembolization combined with microwave ablation for the treatment of hepatocellular carcinoma in rats

Vogl

Qian²,

Tran³

et al. 2017

Diagn Interv Radiol

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H epatocellular carcinoma (HCC) is the fifth most common malignancy among men, and the seventh most common malignancy among women. Although morbidity and mortality are very high, no standardized treatment algorithm exists to date (1). Transarterial chemoembolization (TACE) is a frequently used interventional treatment for patients with inoperable HCC (2). Direct application of drugs into tumor feeding branches, allows for higher local chemotherapeutic concentrations with less systemic side effects. However, TACE has not been shown to notably prolong the overall survival rate, mainly due to local and distal tumor recurrence after treatment (3). Microwave ablation is a minimally invasive technique with low complication rate for the nonsurgical treatment of HCC (4). Electromagnetic waves at frequencies of 900-2450 MHz are used to induce coagulation necrosis. Polar molecules (mainly water dipoles) try to realign themselves with the direction of current in an electromagnetic field. The oscillation produced by constant realignment causes friction and a heating effect. However, it has been shown that local tumor control is highly dependent on complete tumor ablation, and recurrence in larger nodules (> 5 cm in diameter) is remarkably worse than in smaller ones (5, 6).Recently published studies imply that a combination of TACE and local ablation might have a synergistic effect on HCC (7). TACE leads to inflammatory edema, therefore increasing the watery content of the tumor, which the technique of microwave ablation uses to produce heat (8). Furthermore, central tumor parts in close vicinity to the probe receive the greatest thermal insult during physical ablation, while TACE works best on the better vascularized peripheral tumor areas (3). Trials with over 100 patients demonstrated that combined therapy of microwave ablation applied within six weeks after TACE can effective- 150From the Institute for Diagnostic and Interventional Radiology (T.J.V.  t.vogl@em.uni-frankfurt.de, A.T.,

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Large primary hepatocellular carcinoma: Transarterial chemoembolization monotherapy versus combined transarterial chemoembolization‐percutaneous microwave coagulation therapy

Abstract: TACE combined with PMCT had advantages in prolonging OS with satisfying time to progression and improving liver function in patients with large unresectable HCC. The results suggest that further prospective studies are required to confirm the findings of this study.

Cited by 68 publications

References 32 publications

Combined transarterial chemoembolization and microwave ablation versus transarterial chemoembolization in BCLC stage B hepatocellular carcinoma

Combined transarterial chemoembolization and microwave ablation versus transarterial chemoembolization in BCLC stage B hepatocellular carcinoma

A Recent Advance in Image-Guided Locoregional Therapy for Hepatocellular Carcinoma

Study on the effect of chemoembolization combined with microwave ablation for the treatment of hepatocellular carcinoma in rats

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