Small Hepatocellular Carcinoma: Is Radiofrequency Ablation Combined with Transcatheter Arterial Chemoembolization More Effective than Radiofrequency Ablation Alone for Treatment?

Abstract

Combined radiofrequency ablation plus TACE and radiofrequency ablation alone have equivalent effectiveness for the treatment of small (< or =3 cm) HCCs, so the combination treatment may not be necessary.

Utility of percutaneous radiofrequency ablation alone or combined with transarterial chemoembolization for early hepatocellular carcinoma

“…control even when lesions occur on the surface of the liver or near blood vessels. Multiple studies have been conducted on RFA/TACE, and a systematic review (23) performed a meta-analysis of eight clinical trials (24)(25)(26)(27)(28)(29)(30). However, the majority of these studies examined HCC tumors >3 cm in diameter, and only one examined small HCCs (28).…”

“…Multiple studies have been conducted on RFA/TACE, and a systematic review (23) performed a meta-analysis of eight clinical trials (24)(25)(26)(27)(28)(29)(30). However, the majority of these studies examined HCC tumors >3 cm in diameter, and only one examined small HCCs (28). The meta-analysis revealed that rate of local tumor progression, OS, local progression-free survival and event-free survival were not significantly different between the combination therapy and RFA alone.…”

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

“…After stratification for tumor number and size, neither 1-, 3-, and 5-year tumor progression rates nor overall survival significantly differed between the single-tumor group and multi-tumor group. It seems relevant that the two randomized trials reported (39,40) failed to demonstrate a statistically significant advantage for the TACE plus RFA combination versus RFA alone in a cohort of small and intermediate-sized HCCs. As a matter of fact, Morimoto and colleagues demonstrated that such a combination therapy is safe and effective for extending the ablated area, thereby contributing to restricting local tumor progression, but a larger number of patients may be needed to confirm the survival benefits (40).…”

“…In 2009, Shibata and colleagues reported their experience in a prospective randomized trial comparing TACE plus RFA versus RFA alone in patients fulfilling the following inclusion criteria: three or fewer HCC nodules 3 cm in diameter or smaller, CTP class A or B cirrhosis, no imaging evidence of tumor invasion into the major portal or hepatic vein branches, no extrahepatic metastasis, and a platelet count of more than 40,000 cells/mm 3 (39). A total of 89 patients entered the study, 46 in the combined therapy group and 43 in that for RFA alone.…”

Management of “very early” hepatocellular carcinoma on cirrhotic patients

“…Accordingly the debate arises on to what is the best option for these patients: immediate ablation or wait until the tumor grows and then patients afford exception points and have real options of attracting an organ [71] . Several studies have shown the efficacy of local therapies on very early HCC [72][73][74][75][76] . Sala et al [77] reported a 50% survival at 5 years in Child A patients and treatment response in 70% of nodules < 3 cm and 50% in nodules rence out of transplantable criteria and then loose the opportunity for LT. N'Kontchou et al [79] reported promising results with the "two step" strategy, using RFA as first line treatment in patients eligible for LT.…”