Radiofrequency Ablation Combined with Transcatheter Arterial Chemoembolization for the Treatment of Single Hepatocellular Carcinoma of 2 to 5 cm in Diameter: Comparison with Surgical Resection

Abstract

ObjectiveTo compare the effectiveness of radiofrequency ablation (RFA) combined with transcatheter arterial chemoembolization (TACE) with surgical resection in patients with a single hepatocellular carcinoma (HCC) ranging from 2 to 5 cm.Materials and MethodsThe study participants were enrolled over a period of 29 months and were comprised of 37 patients in a combined therapy group and 47 patients in a surgical resection group. RFA was performed the day after TACE, and surgical resection was performed by open laparotomy. The two groups were compared with respect to the length of hospital stay, rates of major complication, and rates of recurrence-free and overall survival.ResultsMajor complications occurred more frequently in the surgical resection group (14.9%) than in the combined therapy group (2.7%). However, there was no statistical significance (p = 0.059). The rates of recurrence-free survival at 1, 2, 3 and 4 years were similar between the combined therapy group (89.2%, 75.2%, 69.4% and 69.4%, respectively) and the surgical resection group (81.8%, 68.5%, 68.5% and 65%, respectively) (p = 0.7962, log-rank test). The overall survival rates at 1, 2, 3 and 4 years were also similar between groups (97.3%, 86.5%, 78.4% and 78.4%, respectively, in the combined therapy group, and 95.7%, 89.4%, 84.3% and 80.3%, respectively, in the surgical resection group) (p = 0.6321, log-rank test).ConclusionWhen compared with surgical resection for the treatment of a single HCC ranging from 2 to 5 cm, RFA combined with TACE shows similar results in terms of recurrence-free and overall survival rates.

Randomized clinical trial of chemoembolization plus radiofrequency ablation versus partial hepatectomy for hepatocellular carcinoma within the Milan criteria

“…The results of the present trial showed that sequential treatment with TACE and RFA was associated with worse RFS and OS than partial hepatectomy. This differs to some extent from previously published work. Kagawa and colleagues showed that sequential treatment with TACE and RFA resulted in similar OS but worse RFS, compared with surgical resection.…”

“…Thus, sequential treatment of TACE and RFA may achieve better or similar therapeutic effects compared with partial hepatectomy. Three retrospective studies have compared these two treatments, but no randomized clinical trials have yet been reported.…”

The Evolving Role of Local Treatments for HCC in the Third Millennium

“…Kagawa and Kim reported their results comparing surgical resection and combined approach of TACE followed by RFA. They reported no differences in terms of overall survival, while recurrencefree survival was in favor of the surgical approach (p=0.01), whereas in the study from Kim and colleagues, no significant difference was found in terms of recurrence-free and overall survival between the two approaches (42,43). The two studies differ for the timing of RFA, which was scheduled on the day after TACE in the study by Kim et al, while in the study of Kagawa et al, it was performed within 2 months of TACE.…”

“…Similarly in 2013, Kim et al compared the outcomes of TACE combined with RFA versus surgery alone in a series of 84 patients affected by HCC (43). The following inclusion criteria were considered for that study: a single HCC of 2-5 cm in the largest dimension, no history of prior treatment for HCC, no major vascular invasion and no evidence of extrahepatic tumor.…”

Current management of hepatocellular carcinoma: An Eastern perspective

“…In addition, synergism between hyperthermia and high concentrations of chemotherapeutic agents may enhance the destruction of microscopic satellite lesions. Recently, a non-randomized controlled study compared RFA plus TACE and surgical resection for the treatment of single HCCs ranging in size from 2 to 5 cm [139] . The study showed that the combination therapy was as effective as resection in terms of recurrence-free survival (69.4% and 65%, respectively, at 4 years, P value is nonsignificant) and overall survival (78.4% and 80.3%, respectively, at 4 years, P value is nonsignificant).…”