Combination transarterial chemoembolization and microwave ablation improves local tumor control for 3- to 5-cm hepatocellular carcinoma when compared with transarterial chemoembolization alone
- 44 Downloads
To compare transarterial chemoembolization (TACE) monotherapy to combination TACE and microwave ablation (MWA) for local control of 3- to 5-cm hepatocellular carcinoma (HCC).
Patients with HCC between 3 and 5 cm treated with TACE monotherapy or combination TACE + MWA at a single institution between 2007 and 2016 were retrospectively reviewed. Twenty-four HCCs (median diameter 3.8 cm) in 16 patients (13 males; median age 64 years) were treated using TACE monotherapy. Combination TACE + MWA was used to treat 23 HCCs (median diameter 4.2 cm) in 22 patients (18 males; median age 61 years). Microwave ablation was performed at a target time of two weeks following TACE. Individual tumors were followed by serial contrast-enhanced CT or MR. Response to treatment was evaluated on a tumor-by-tumor basis using mRECIST criteria with the primary outcome being local tumor progression (LTP). Data were analyzed using Fisher’s exact test for categorical variables and Wilcoxon rank sum test for continuous variables. Time to LTP was estimated with the Kaplan–Meier method.
Relative to TACE monotherapy, TACE + MWA provided a trend toward both a lower rate of LTP (34.8% vs. 62.5%, p = 0.11) and a higher complete response rate (65.2% vs. 37.5%; p = 0.12). Time to LTP (22.3 months vs. 4.2 months; p = 0.001) was significantly longer in the TACE + MWA group compared to TACE monotherapy.
Combination therapy with TACE and microwave ablation improves local control and increases time to LTP for 3–5 cm HCC.
Compliance with ethical standards
No funding was provided for this study.
Conflict of interest
Christopher L. Brace: (1) consulting fees, NeuWave Medical, Inc., Madison, WI (2) shareholder and consulting fees, Symple Surgical, Inc., Menlo Park, CA. J. Louis Hinshaw: Consulting fees, NeuWave Medical, Inc., Madison, WI. Paul Laeseke: consulting fees, NeuWave Medical, Inc., Madison, WI. Fred T. Lee, Jr: (1) Board Member, Stockholder, and Grant recipient (pending) Histosonics, Inc., Ann Arbor, MI (2) Paid consultant, Ethicon, Inc., Somerville, NJ (3) Stockholder, Elucent, Inc., Minneapolis, MN (4) Patent holder and Royalties, Medtronic/Covidien, Inc., Boulder, CO (5) Stockholder, Zurex, Inc., HealthMyne, Inc., and Eximis Surgical, Inc. Meghan G. Lubner: (1) Grant recipient, Ethicon, Inc., Somerville, NJ (2) Grant recipient, Philips, Amsterdam, Netherlands. Shane A. Wells: consulting fees, NeuWave Medical, Inc., Madison, WI. Timothy J. Ziemlewicz: consulting fees, NeuWave Medical, Inc., Madison, WI.
All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study prior to undergoing procedures. This retrospective study was approved by our institutional review board, and the requirement for informed consent was waived.
- 1.Ferlay J, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F (2013)Google Scholar
- 4.Mazzaferro V, Battiston C, Perrone S, et al. (2004) Radiofrequency ablation of small hepatocellular carcinoma in cirrhotic patients awaiting liver transplantation: a prospective study. Ann Surg 240(5):900–909. https://doi.org/10.1097/00054725-200411000-00024 CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Ginsburg M, Zivin SP, Wroblewski K, et al. (2015) Comparison of combination therapies in the management of hepatocellular carcinoma: transarterial chemoembolization with radiofrequency ablation versus microwave ablation. J Vasc Interv Radiol 26(3):330–341. https://doi.org/10.1016/j.jvir.2014.10.047 CrossRefPubMedGoogle Scholar
- 20.Goldberg SN, Saldinger PF, Gazelle GS, et al. (2001) Percutaneous tumor ablation: increased necrosis with combined radio-frequency ablation and intratumoral doxorubicin injection in a rat breast tumor model. Radiology 220(2):420–427. https://doi.org/10.1148/radiology.220.2.r01au44420 CrossRefPubMedGoogle Scholar
- 21.Mostafa EM, Ganguli S, Faintuch S, Mertyna P, Goldberg SN (2008) Optimal strategies for combining transcatheter arterial chemoembolization and radiofrequency ablation in rabbit VX2 hepatic tumors. J Vasc Interv Radiol 19(12):1740–1748. https://doi.org/10.1016/j.jvir.2008.08.028 CrossRefPubMedGoogle Scholar
- 25.Xu LF, Sun HL, Chen YT, et al. (2013) Large primary hepatocellular carcinoma: transarterial chemoembolization monotherapy versus combined transarterial chemoembolization-percutaneous microwave coagulation therapy. J Gastroenterol Hepatol 28(3):456–463. https://doi.org/10.1111/jgh.12088 CrossRefPubMedGoogle Scholar