Midterm outcomes in patients with intermediate‐sized hepatocellular carcinoma

Abstract

BACKGROUND:To improve the efficacy of radiofrequency ablation (RFA) for the treatment of intermediate-sized hepatocellular carcinomas (HCCs), the authors compared RFA combined with transcatheter arterial chemoembolization (TACE) to RFA alone. METHODS: The authors randomly assigned 37 patients with solitary HCCs (diameter, 3.1-5.0 cm in the greatest dimension) to 2 groups: the TACE-RFA group, in which the patients received TACE followed by RFA on the same day, and the RFA group, in which the patients received only RFA. RESULTS: Technical success was achieved after 1.4 AE 0.5 RFA sessions in the RFA group and after 1.1 AE 0.2 RFA sessions in the TACE-RFA group (P < .01). The mean diameters of the longer and shorter axes of the RFA-induced ablated areas were 50 AE 8.0 mm and 41 AE 7.1 mm, respectively, in the RFA group and 58 AE 13.2 mm and 50 AE 11.3 mm, respectively, in the TACE-RFA group; the mean diameters of the shorter axes were significantly different (P ¼ .012). The rates of local tumor progression at the end of the third year in the RFA and TACE-RFA groups were 39% and 6%, respectively (P ¼ .012). The 3-year survival rates of the patients in the RFA and TACE-RFA groups were 80% and 93%, respectively (P ¼ .369). CONCLUSIONS: In patients with intermediate-sized HCCs, RFA combined with TACE is more effective than RFA alone for extending the ablated area in fewer treatment sessions and for decreasing the local tumor progression rate. Cancer 2010;116:5452-60.

Hepatic radiofrequency ablation:in vivoandex vivocomparisons of 15-gauge (G) and 17-G internally cooled electrodes

“…In the aspect of RFA techniques, overlapping technique and combined treatment with transcatheter arterial chemoembolization can be used. [7][8][9] Another strategy is to use switching monopolar, bipolar or multipolar modes to deliver radiofrequency (RF) energy more efficiently. 10,11 Sufficient ablation margin can also be achieved by more efficient electrodes: internally cooled electrode increases the size of ablation zone by preventing charring around the electrode tip.…”

Current management of hepatocellular carcinoma: An Eastern perspective

“…A retrospective study conducted in Korea evaluated the therapeutic efficacy of RFA plus TACE in patients with medium-sized (3.1-5.0 cm) HCCs and found that it significantly lowered the local tumor progression rate compared with RFA alone (55% and 86% at 5 years, respectively; P < 0.001) [135] . Subsequently, several randomized controlled trials compared RFA and RFA plus TACE in Japan and China [136,137] , and a meta-analysis of these studies showed that the combined treatment was significantly associated with higher overall survival (OR = 1.85, 95%CI: 1.26-2.71) and recurrence-free survival (OR = 2.13, 95%CI: 1.41-3.20) rates [138] . The benefits of the combination therapy could be attributed to the avoidance of the heat sink effect and the subsequent increase in the size of the thermal coagulation zone.…”

Locoregional treatment for hepatocellular carcinoma: The best is yet to come

“…The rationale behind lipiodol TACE-preceded RFA is as follows: a state of transient liver infarction is induced by the lipiodol, which regurgitates into the portal branches via the peribiliary venous plexus, thereby decreasing the heat sink effect, expanding the ablative area, and promoting the ablation of satellite lesions [46] . Several studies have reported significantly better survival rates with TACE-preceded RFA compared to RFA alone for intermediate-sized lesions [45,[47][48] . In another administration method, TACE may follow RFA, with TACE expected to handle the peripheral part of a tumor where RFA achieves sub-optimal temperatures [45] .…”