Radiofrequency ablation combined with transcatheter arterial chemioembolization in the treatment of advanced hepatocellular carcinoma

Background : Treatment of HCC complicating liver cirrhosis still remains a controversial issue, due to both the characteristics of the malignant disease per se and to the problems of underlying associated chronic liver disease. In particular, for patients with HCC not elegible for “curative” options (advanced HCC) (who, despite of surveillance programs, still remain a relevant amount in the clinical practice) there is no standard therapy. Aim: to evaluate efficacy of combined treatment with radiofrequency ablation (RFA) and transcatether arterial chemio-embolization (TACE) in the treatment of advanced hepatocellular carcinoma.Materials and Methods: We compared the treatment efficacy (cumulative survival rate after treatment) in 30 HCC-confirmed (imaging and/or histological proven) patients treated with combined therapy (simultaneous application of TACE and RFA; RFA was performed on to the greatest node in case of multiple nodes) [RFA-TACE group] with HCC-confirmed patients treated only by TACE [TACE group] or by conservative option [Control group]. Patients in TACE and Control groups were chosen as matching more as possible with patients in RFA-TACE group with regard to all possible factors influencing survival. Patients in TACE group could not undergo RFA due to technical (site of tumour, lesion undetectable at ultrasound, etc) and/or refuse of treatment. Control group could not undergo TACE due to portal complete or partial thrombosis or site of tumour. All patients were monitored at one-three months after treatment and every six months by imaging to control for treatment success and neoplasm relapse.Results: Characteristics of the considered groups are resumed in the table below. No patients were lost at follow-up. Survival rates were better in TACE-RFA group than TACE and control group. The median survival time was 16.1 months for TACE-RFA, 12.1 for TACE and 8.4 for Controls. The 6-month, 1-year and 2-years survival rate was 78%, 71% and 47% TACE-RFA group vs. 72%, 66% and 40% and 65%, 55% and 39% in TACE and Control group (p=.025 and p=.002 with respect to TACE-RFA group, i.e significant after Bonferroni correction for multiple comparisons).RFA-TACE (n=30)TACE (n=34)Controls (n=35)Age67±764±868±10Sex (males)22 (73.3%)25 (73.5%)26 (74.3%)Child score6.8±1.56.8±1.37.1±1.9Child group A/B11/1911/2310/25Nodes (mean)3.1±1.23.2 ±1.13.4±1.6Major node dimension3.9±1.53.8±1.63.9±1.8Single / Multiple node8/209/269/26BCLC stage ( B/C)16/1416/1815/20Milan criteria1 2/ 3 17/1315/1915/20Duration of Liver Disease (years) 8.4±4.48.7±3.58.6±3.5Etiology : Viral vs. Nonviral22/828/628/71 2= Single node > 3 and < 5 cm or multiple nodes (max 3) with the greatest ≤ 3 cm; 3= Single node > 5 cm or multiple nodes (more than 3 or up to 3 with the greatest > 3 cm)Conclusion: The combination of RFA and TACE is a promising approach for the treatment of advanced HCC complicating liver cirrhosis, nevertheless a better definition of patient’s characteristics and technical approaches are needed together with large scale-randomized trial for confirmation of results.