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Combination transarterial chemoembolization and microwave ablation improves local tumor control for 3- to 5-cm hepatocellular carcinoma when compared with transarterial chemoembolization alone

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Abstract

Purpose

To compare transarterial chemoembolization (TACE) monotherapy to combination TACE and microwave ablation (MWA) for local control of 3- to 5-cm hepatocellular carcinoma (HCC).

Methods

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.

Results

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.

Conclusions

Combination therapy with TACE and microwave ablation improves local control and increases time to LTP for 3–5 cm HCC.

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Authors and Affiliations

  1. Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA

    Amanda R. Smolock, Mircea M. Cristescu, Audrey Hinshaw, Shane A. Wells, Timothy J. Ziemlewicz, Meghan G. Lubner, Prasad S. Dalvie, J. Louis Hinshaw, Christopher L. Brace, Orhan S. Ozkan, Fred T. Lee Jr. & Paul Laeseke

  2. Departments of Biomedical Engineering, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA

    Christopher L. Brace & Fred T. Lee Jr.

  3. Departments of Medical Physics, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA

    Christopher L. Brace

  4. Departments of Biostatistics and Medical Informatics, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA

    Kaitlin M. Woo

Authors
  1. Amanda R. Smolock
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  2. Mircea M. Cristescu
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  3. Audrey Hinshaw
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  5. Shane A. Wells
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  6. Timothy J. Ziemlewicz
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  7. Meghan G. Lubner
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  8. Prasad S. Dalvie
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  9. J. Louis Hinshaw
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  10. Christopher L. Brace
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  13. Paul Laeseke
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Corresponding author

Correspondence to Paul Laeseke.

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Funding

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.

Ethical approval

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

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.

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Smolock, A.R., Cristescu, M.M., Hinshaw, A. et al. Combination transarterial chemoembolization and microwave ablation improves local tumor control for 3- to 5-cm hepatocellular carcinoma when compared with transarterial chemoembolization alone. Abdom Radiol 43, 2497–2504 (2018). https://doi.org/10.1007/s00261-018-1464-9

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