Abstract
Purpose
To report the results of combined therapy with transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) for early stage hepatocellular carcinoma (HCC) considered infeasible for ultrasound (US)-guided RFA in comparison with those of TACE monotherapy.
Methods
From January 2007 through December 2010, 91 patients with early or very early stage HCC infeasible for US-guided RFA received either TACE alone (TACE group; n = 54) or TACE immediately followed by RFA (TACE–RFA group; n = 37) as a first-line treatment. 1-month tumor response, time to progression (TTP), and overall survival (OS) rates were calculated. Univariate and multivariate analyses were performed to identify prognostic factors.
Results
TACE–RFA group showed a better 1-month tumor response than TACE group (P < .001). The mean TTP was 29.7 ± 3.4 months (95 % confidence intervals [CIs] 23.0–36.5) in TACE group and 34.9 ± 2.8 months (95 % CIs 29.4–40.4) in TACE–RFA group. TACE–RFA group had a significantly longer TTP (P = .014). Cumulative 1-, 2-, and 3-year OS rates in the TACE and TACE–RFA groups were 91, 79, and 71 % and 100, 97, and 93 %, respectively (P = .008). Initial treatment of TACE was found to be the only significant risk factor for tumor progression and OS in multivariate analysis.
Conclusion
TACE–RFA combination therapy appears superior to TACE monotherapy in terms of 1-month tumor response, TTP, and OS when performed for early stage HCC infeasible for US-guided RFA.
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References
Bruix J, Sherman M. Management of hepatocellular carcinoma. Hepatology. 2005;42(5):1208–36.
Bruix J, Sherman M. American Association for the Study of Liver D. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53(3):1020–2.
Livraghi T. Single HCC smaller than 2 cm: surgery or ablation: interventional oncologist’s perspective. J Hepatobiliary Pancreat Sci. 2010;17(4):425–9.
Massarweh NN, Park JO, Farjah F, Yeung RS, Symons RG, Vaughan TL, Baldwin LM, Flum DR. Trends in the utilization and impact of radiofrequency ablation for hepatocellular carcinoma. J Am Coll Surg. 2010;210(4):441–8.
Rhim H, Lee MH, Kim YS, Choi D, Lee WJ, Lim HK. Planning sonography to assess the feasibility of percutaneous radiofrequency ablation of hepatocellular carcinomas. Am J Roentgenol. 2008;190(5):1324–30.
Song KD, Lee MW, Rhim H, Cha DI, Chong Y, Lim HK. Fusion imaging-guided radiofrequency ablation for hepatocellular carcinomas not visible on conventional ultrasound. Am J Roentgenol. 2013;201(5):1141–7.
Lim S, Lee MW, Rhim H, Cha DI, Kang TW, Min JH, Song KD, Choi SY, Lim HK. Mistargeting after fusion imaging-guided percutaneous radiofrequency ablation of hepatocellular carcinomas. J Vasc Interv Radiol. 2014;25(2):307–14.
Bargellini I, Sacco R, Bozzi E, Bertini M, Ginanni B, Romano A, Cicorelli A, Tumino E, Federici G, Cioni R, Metrangolo S, Bertoni M, Bresci G, Parisi G, Altomare E, Capria A, Bartolozzi C. Transarterial chemoembolization in very early and early-stage hepatocellular carcinoma patients excluded from curative treatment: a prospective cohort study. Eur J Radiol. 2012;81(6):1173–8.
Song YG, Shin SW, Cho SK, Choi D, Rhim H, Lee MW, Kim YS, Park KB, Park HS, Choo SW, Do YS, Choo IW, Hyun D. Transarterial chemoembolization as first-line therapy for hepatocellular carcinomas infeasible for ultrasound-guided radiofrequency ablation: a retrospective cohort study of 116 patients. Acta Radiol. 2015;56(1):70–7.
Ni JY, Liu SS, Xu LF, Sun HL, Chen YT. Meta-analysis of radiofrequency ablation in combination with transarterial chemoembolization for hepatocellular carcinoma. World J Gastroenterol. 2013;19(24):3872–82.
Lee MW, Kim YJ, Park SW, Hwang JH, Jung SI, Jeon HJ, Kwon WK. Percutaneous radiofrequency ablation of small hepatocellular carcinoma invisible on both ultrasonography and unenhanced CT: a preliminary study of combined treatment with transarterial chemoembolisation. Br J Radiol. 2009;82(983):908–15.
Kang SG, Yoon CJ, Jeong SH, Kim JW, Lee SH, Lee KH, Kim YH. Single-session combined therapy with chemoembolization and radiofrequency ablation in hepatocellular carcinoma less than or equal to 5 cm: a preliminary study. J Vasc Interv Radiol. 2009;20(12):1570–7.
Wang ZJ, Wang MQ, Duan F, Song P, Liu FY, Wang Y, Yan JY, Li K, Yuan K. Clinical application of transcatheter arterial chemoembolization combined with synchronous C-arm cone-beam CT guided radiofrequency ablation in treatment of large hepatocellular carcinoma. Asian Pac J Cancer Prev. 2013;14(3):1649–54.
Song I, Rhim H, Lim HK, Kim YS, Choi D. Percutaneous radiofrequency ablation of hepatocellular carcinoma abutting the diaphragm and gastrointestinal tracts with the use of artificial ascites: safety and technical efficacy in 143 patients. Eur Radiol. 2009;19(11):2630–40.
Brown DB, Nikolic B, Covey AM, Nutting CW, Saad WE, Salem R, Sofocleous CT, Sze DY. Quality improvement guidelines for transhepatic arterial chemoembolization, embolization, and chemotherapeutic infusion for hepatic malignancy. J Vasc Interv Radiol. 2012;23(3):287–94.
Goldberg SN, Grassi CJ, Cardella JF, Charboneau JW, Dodd GD 3rd, Dupuy DE, Gervais D, Gillams AR, Kane RA, Lee FT Jr, Livraghi T, McGahan J, Phillips DA, Rhim H, Silverman SG. Image-guided tumor ablation: standardization of terminology and reporting criteria. Radiology. 2005;235(3):728–39.
Lencioni R, Llovet JM. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis. 2010;30(1):52–60.
Brown DB, Gould JE, Gervais DA, Goldberg SN, Murthy R, Millward SF, Rilling WS, Geschwind JF, Salem R, Vedantham S, Cardella JF, Soulen MC. Transcatheter therapy for hepatic malignancy: standardization of terminology and reporting criteria. J Vasc Interv Radiol. 2009;20(Suppl 7):S425–34.
Kim JW, Kim JH, Sung KB, Ko HK, Shin JH, Kim PN, Choi HK, Ko GY, Yoon HK, Chun SY, Gwon DI. Transarterial chemoembolization vs. radiofrequency ablation for the treatment of single hepatocellular carcinoma 2 cm or smaller. Am J Gastroenterol. 2014;109(8):1234–40.
Hsu CY, Huang YH, Chiou YY, Su CW, Lin HC, Lee RC, Chiang JH, Huo TI, Lee FY, Lee SD. Comparison of radiofrequency ablation and transarterial chemoembolization for hepatocellular carcinoma within the Milan criteria: a propensity score analysis. Liver Transpl. 2011;17(5):556–66.
Yang HJ, Lee JH, Lee DH, Yu SJ, Kim YJ, Yoon JH, Kim HC, Lee JM, Chung JW, Yi NJ, Lee KW, Suh KS, Lee HS. Small single-nodule hepatocellular carcinoma: comparison of transarterial chemoembolization, radiofrequency ablation, and hepatic resection by using inverse probability weighting. Radiology. 2014;271(3):909–18.
Hsu KF, Chu CH, Chan DC, Yu JC, Shih ML, Hsieh HF, Hsieh TY, Yu CY, Hsieh CB. Superselective transarterial chemoembolization vs hepatic resection for resectable early-stage hepatocellular carcinoma in patients with Child-Pugh class a liver function. Eur J Radiol. 2012;81(3):466–71.
Yamakado K, Nakatsuka A, Takaki H, Yokoi H, Usui M, Sakurai H, Isaji S, Shiraki K, Fuke H, Uemoto S, Takeda K. Early-stage hepatocellular carcinoma: radiofrequency ablation combined with chemoembolization versus hepatectomy. Radiology. 2008;247(1):260–6.
Kim JW, Kim JH, Won HJ, Shin YM, Yoon HK, Sung KB, Kim PN. Hepatocellular carcinomas 2–3 cm in diameter: transarterial chemoembolization plus radiofrequency ablation vs. radiofrequency ablation alone. Eur J Radiol. 2012;81(3):e189–93.
Shibata T, Isoda H, Hirokawa Y, Arizono S, Shimada K, Togashi K. Small hepatocellular carcinoma: is radiofrequency ablation combined with transcatheter arterial chemoembolization more effective than radiofrequency ablation alone for treatment? Radiology. 2009;252(3):905–13.
Okuwaki Y, Nakazawa T, Shibuya A, Ono K, Hidaka H, Watanabe M, Kokubu S, Saigenji K. Intrahepatic distant recurrence after radiofrequency ablation for a single small hepatocellular carcinoma: risk factors and patterns. J Gastroenterol. 2008;43(1):71–8.
Xu HX, Lu MD, Xie XY, Yin XY, Kuang M, Chen JW, Xu ZF, Liu GJ. Prognostic factors for long-term outcome after percutaneous thermal ablation for hepatocellular carcinoma: a survival analysis of 137 consecutive patients. Clin Radiol. 2005;60(9):1018–25.
Xie H, Wang H, An W, Ma W, Qi R, Yang B, Liu C, Gao Y, Xu B, Wang W. The efficacy of radiofrequency ablation combined with transcatheter arterial chemoembolization for primary hepatocellular carcinoma in a cohort of 487 patients. PLoS One. 2014;9(2):e89081.
Takaki H, Yamakado K, Nakatsuka A, Yamada T, Uraki J, Kashima M, Yamanaka T, Shiraki K, Takei Y, Takeda K. Computed tomography fluoroscopy-guided radiofrequency ablation following intra-arterial iodized-oil injection for hepatocellular carcinomas invisible on ultrasonographic images. Int J Clin Oncol. 2013;18(1):46–53.
Shibata T, Shibata T, Maetani Y, Kubo T, Itoh K, Togashi K, Hiraoka M. Transthoracic percutaneous radiofrequency ablation for liver tumors in the hepatic dome. J Vasc Interv Radiol. 2004;15(11):1323–7.
Toyoda M, Kakizaki S, Horiuchi K, Katakai K, Sohara N, Sato K, Takagi H, Mori M, Nakajima T. Computed tomography-guided transpulmonary radiofrequency ablation for hepatocellular carcinoma located in hepatic dome. World J Gastroenterol. 2006;12(4):608–11.
Lee MW, Kim YJ, Park SW, Yu NC, Choe WH, Kwon SY, Lee CH. Biplane fluoroscopy-guided radiofrequency ablation combined with chemoembolisation for hepatocellular carcinoma: initial experience. Br J Radiol. 2011;84(1004):691–7.
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Dongho Hyun, Sung Ki Cho, Sung Wook Shin, Kwang Bo Park, Hong Suk Park, Sung Wook Choo, Young Soo Do, In-wook Choo, Min Woo Lee, Hyunchul Rhim, and Hyo Keun Lim declare that they have no conflict of interest.
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All procedures performed in 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. For this type of study, formal consent is not required.
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Hyun, D., Cho, S.K., Shin, S.W. et al. Early Stage Hepatocellular Carcinomas Not Feasible for Ultrasound-Guided Radiofrequency Ablation: Comparison of Transarterial Chemoembolization Alone and Combined Therapy with Transarterial Chemoembolization and Radiofrequency Ablation. Cardiovasc Intervent Radiol 39, 417–425 (2016). https://doi.org/10.1007/s00270-015-1194-0
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DOI: https://doi.org/10.1007/s00270-015-1194-0