Transcatheter arterial chemoembolization monotherapy vs combined transcatheter arterial chemoembolization–percutaneous microwave coagulation therapy for massive hepatocellular carcinoma (≥10 cm)

Abstract

BackgroundThe prognosis of massive hepatocellular carcinomas (MHCCs; ≥10 cm) remains worse.PurposeThe aim of this study was to evaluate the clinical benefits of transcatheter arterial chemoembolization (TACE) or TACE combined with percutaneous microwave coagulation therapy (PMCT) and the long-term survival rate of MHCC patients treated with these techniques.Patients and methodsA retrospective study was performed using data involving 102 MHCC patients admitted to the Second Hospital of Nanjing from September 2010 to August 2015. The median interval between treatments and overall survival (OS) was hierarchically analyzed using log-rank tests. Multivariate analysis was done using Cox regression model analysis.ResultsThe median survival time of MHCC patients was 3 months (range, 1–10 months) in the palliative group, 3 months (range, 1–39 months) in the TACE group, and 7.5 months (range, 3–30 months) in the TACE–PMCT group (P=0.038). The 6-, 12-, and 18-month OS rates for MHCC patients were 15%, 0%, and 0% in the palliative group, 30%, 25.63%, and 17.97% in the TACE group, and 50%, 41.67%, and 16.67% in the TACE–PMCT group, respectively (P=0.0467). In addition, TACE sessions had positive correlation with the survival time of MHCC patients (rho = 0.462, P<0.001). TACE treatment more than three times (HR =0.145, P<0.001) was an independent predictor of the survival of MHCC patients, which was identified by the Cox regression model analysis.ConclusionsThese results indicated that TACE–PMCT treatment in MHCC patients had advantages in prolonging OS and improving liver function. Multiple TACE treatments might be a suitable treatment for the MHCC patients.

Hyperthermia ablation combined with transarterial chemoembolization versus monotherapy for hepatocellular carcinoma: A systematic review and meta‐analysis

“…Identification flow of the studies is exhibited as Figure 1 and Data . A total of 36 eligible studies 39–74 involving a large sample amount of 5036 patients were included finally for the systematic review and meta‐analysis (Figure 1, Table 1, Data ). All of the included studies 39–74 were published in SCI journals and included in the Web of Science with good quality of reports.…”

“…A total of 36 eligible studies 39–74 involving a large sample amount of 5036 patients were included finally for the systematic review and meta‐analysis (Figure 1, Table 1, Data ). All of the included studies 39–74 were published in SCI journals and included in the Web of Science with good quality of reports. The main features of the included trials 39–74 are detailedly presented in Table 1 and Data .…”

“…HATACE has a broad clinical applications for different stages of HCC based on the studies for systematic review, including early or very early stage 39,42,44,47,53,56 (Barcelona Clinic Liver Cancer [BCLC] stage 0 & A), intermediate stage 42,[45][46][47][48][49] (BCLC stage B), and advanced stage 41,47,48,54 (BCLC stage C & D). However, conflicting conclusions exist among some different studies 39,56,63,64,68,69,73 in regard to the survival benefit from HATACE compared with HA monotherapy for small (≤3 cm) HCC.…”

Prognostic Significance of Tumor Growth Rate (TGR) in Patients with Huge Hepatocellular Carcinoma Undergoing Transcatheter Arterial Chemoembolization

“…Another study demonstrated that TACE following percutaneous microwave coagulation therapy in HHCC patients was an ideal treatment strategy. The 6-, 12-, and 18-month OS rates for HHCC patients were 50%, 41.67%, and 16.67% in the combination therapy group [ 22 ]. In our study, the HHCC patients with subsequent combination therapy revealed a longer OS in the high-TGR group, which was in accordance with previous research.…”

Dexamethasone prevents TACE-induced adverse events

“…TACE is recognized as an efficient and safe therapeutic procedure for unresectable multifocal and massive hepatocellular carcinoma (HCC). [ 4 , 5 ] By inducing ischemia and necrosis of tumor tissue through arterial chemoembolization, TACE efficiently suppresses the development of liver cancer and can be applied to recurrence, which occurs quite commonly in HCC; therefore, TACE contributes to tumor control and retreatment. [ 6 , 7 ] Given its feasibility and safety, TACE has been utilized for liver cancer for decades; nevertheless, postembolization syndrome (PES), which refers to a series of typical symptoms including fever, abdominal pain, and nausea/vomiting generally induced by TACE, turns out to be a notable clinical issue related to prognosis.…”