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Current status of the combination therapy of transarterial chemoembolization and local ablation for hepatocellular carcinoma

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Abstract

Purpose of review

To review the current status and ideal time interval of the combination therapy of transarterial chemoembolization (TACE) and local ablation for patients with HCCs.

Recent findings

In recent years, local ablation has been proposed as an alternative curative treatment in the management of HCC. Additionally, many treatment options are available including TACE molecular targeted agents and immune checkpoint inhibitors. Similar overall survival rates and prognoses have been obtained with radiofrequency ablation (RFA) microwave ablation (MWA) and cryoablation for patients with HCCs up to 3 cm in diameter. Yet, MWA has shown superiority in treating large HCCs while cryoablation has several advantages compared with RFA or MWA. Furthermore, the treatment strategy of TACE combined with local ablation is widely accepted by many physicians in order to further increase the survival rate and improve the prognosis of patients with HCCs. However, the time interval between the two sessions of combination therapy remains uncertain in the current guidelines.

Summary

Combination therapy of TACE and local ablation has advantages on survival and prognosis in patients with HCC compared with monotherapy. Good patient selection for the right modality needs to be carried out to guarantee the most efficacious treatment for HCC patients. Further studies are needed to find the ideal time interval between TACE and local ablation for HCC patients.

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References

  1. Forner A, Reig M, Bruix J (2018) Hepatocellular carcinoma. Lancet 391:1301–1314

    Article  PubMed  Google Scholar 

  2. Torre L, Bray F, Siegel R, et al. (2015) Global cancer statistics, 2012. Ca Cancer J Clin 65:87–108

    Article  PubMed  Google Scholar 

  3. Bertuccio P, Turati F, Carioli G, et al. (2017) Global Trends and Predictions in Hepatocellular Carcinoma Mortality. J Hepatol 67:302–309

    Article  PubMed  Google Scholar 

  4. Chen W, Zheng R, Baade PD, et al. (2016) Cancer statistics in China, 2015. Ca Cancer J Clin 66:115–132

    Article  PubMed  Google Scholar 

  5. Crocetti L, Bargellini I, Cioni R (2017) Loco-regional treatment of HCC: current status. Clin Radiol 72:626–635

    Article  CAS  PubMed  Google Scholar 

  6. Kishore S, Friedman T, Madoff DC (2017) Update on Embolization Therapies for Hepatocellular Carcinoma. Curr Oncol Rep 19:40

    Article  PubMed  Google Scholar 

  7. Sakr OS, Berndt S, Carpentier G, et al. (2016) Arming embolic beads with anti-VEGF antibodies and controlling their release using LbL technology. J Control Release 224:199–207

    Article  CAS  PubMed  Google Scholar 

  8. Jeng WJ, Lin CC, Chen WT, et al. (2014) Adjuvant Therapy for Hepatocellular Carcinoma after Curative Treatment. Dig Dis 32:747–754

    Article  PubMed  Google Scholar 

  9. Nault JC, Sutter O, Nahon P, et al. (2017) Percutaneous treatment of hepatocellular carcinoma: state of the art and innovations. J Hepatol 68:783–797

    Article  PubMed  Google Scholar 

  10. Ng KKC, Chok KSH, Chan ACY, et al. (2017) Randomized clinical trial of hepatic resection versus radiofrequency ablation for early-stage hepatocellular carcinoma. Br J Surg 104:1775–1784

    Article  CAS  PubMed  Google Scholar 

  11. Kang TW, Lim HK, Lee MW, et al. (2015) Aggressive Intrasegmental Recurrence of Hepatocellular Carcinoma after Radiofrequency Ablation: Risk Factors and Clinical Significance. Radiology 276:274–285

    Article  PubMed  Google Scholar 

  12. Carmi L, Georgiades C (2010) Combination percutaneous and intraarterial therapy for the treatment of hepatocellular carcinoma: a review. Semin Intervent Radiol 27:296–301

    Article  PubMed  PubMed Central  Google Scholar 

  13. Hyun D, Cho SK, Shin SW, et al. (2017) Combined transarterial chemoembolization and radiofrequency ablation for small treatment-naïve hepatocellular carcinoma infeasible for ultrasound-guided radiofrequency ablation: long-term outcomes. Acta Radiol 59:773–781

    Article  PubMed  Google Scholar 

  14. Min JH, Lee MW, Cha DI, et al. (2013) Radiofrequency Ablation Combined with Chemoembolization for Intermediate-Sized (3–5 cm) Hepatocellular Carcinomas Under Dual Guidance of Biplane Fluoroscopy and Ultrasonography. Korean J Radiol 14:248–258

    Article  PubMed  PubMed Central  Google Scholar 

  15. Tanaka M, Ando E, Simose S, et al. (2014) Radiofrequency ablation combined with transarterial chemoembolization for intermediate hepatocellular carcinoma. Hepatol Res 44:194–200

    Article  PubMed  Google Scholar 

  16. Yin X, Zhang L, Wang YH, et al. (2014) Transcatheter arterial chemoembolization combined with radiofrequency ablation delays tumor progression and prolongs overall survival in patients with intermediate (BCLC B) hepatocellular carcinoma. BMC Cancer 14:849

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Azuma S, Asahina Y, Nishimurasakurai Y, et al. (2016) Efficacy of additional radiofrequency ablation after transcatheter arterial chemoembolization for intermediate hepatocellular carcinoma. Hepatol Res 46:312–319

    Article  CAS  PubMed  Google Scholar 

  18. Hyun D, Cho SK, Shin SW, et al. (2016) 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

    Article  PubMed  Google Scholar 

  19. Yuan G, Zeng CL, Zhu DD, et al. (2017) Influences of RFA combined with TACE on the HIF-1α and EGR level of patients with primary hepatic carcinoma. Eur Rev Med Pharmacol Sci 21:1738–1745

    CAS  PubMed  Google Scholar 

  20. Yang D, Luo K, Liu H, et al. (2016) Meta-analysis of transcatheter arterial chemoembolization plus radiofrequency ablation versus transcatheter arterial chemoembolization alone for hepatocellular carcinoma. Oncotarget 8:2960–2970

    PubMed Central  Google Scholar 

  21. Morimoto M, Numata K, Kondou M, et al. (2010) Midterm outcomes in patients with intermediate-sized hepatocellular carcinoma: a randomized controlled trial for determining the efficacy of radiofrequency ablation combined with transcatheter arterial chemoembolization. Cancer 116:5452–5460

    Article  PubMed  Google Scholar 

  22. Peng ZW, Zhang YJ, Chen MS, et al. (2013) Radiofrequency ablation with or without transcatheter arterial chemoembolization in the treatment of hepatocellular carcinoma: a prospective randomized trial. J Clin Oncol 31:426–432

    Article  PubMed  Google Scholar 

  23. Tamai T, Oshige A, Tabu K, et al. (2017) Utility of percutaneous radiofrequency ablation alone or combined with transarterial chemoembolization for early hepatocellular carcinoma. Oncol Lett 14:3199–3206

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Siriapisith T, Siwasattayanon P, Tongdee T (2012) Radiofrequency ablation alone versus radiofrequency ablation combined with chemoembolization in unresectable hepatocellular carcinoma. J Med Assoc Thai 95:430–436

    PubMed  Google Scholar 

  25. Lan T, Chang L, Rahmathullah MN, et al. (2016) Comparative Efficacy of Interventional Therapies for Early-stage Hepatocellular Carcinoma: A PRISMA-compliant Systematic Review and Network Meta-analysis. Medicine 95:e3185

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Li L, Tian J, Liu P, et al. (2016) Transarterial chemoembolization combination therapy vs monotherapy in unresectable hepatocellular carcinoma: a meta-analysis. Tumori 2016:301–310

    Article  PubMed  Google Scholar 

  27. Wang X, Hu Y, Ren M, et al. (2016) Efficacy and Safety of Radiofrequency Ablation Combined with Transcatheter Arterial Chemoembolization for Hepatocellular Carcinomas Compared with Radiofrequency Ablation Alone: A Time-to-Event Meta-Analysis. Korean J Radiol 17:93–102

    Article  PubMed  PubMed Central  Google Scholar 

  28. Bholee AK, Peng K, Zhou Z, et al. (2017) Radiofrequency ablation combined with transarterial chemoembolization versus hepatectomy for patients with hepatocellular carcinoma within Milan criteria: a retrospective case–control study. Clin Transl Oncol 19:844–852

    Article  CAS  PubMed  Google Scholar 

  29. Pan T, Mu LW, Wu C, et al. (2017) Comparison of Combined Transcatheter Arterial Chemoembolization and CT-guided Radiofrequency Ablation with Surgical Resection in Patients with Hepatocellular Carcinoma within the Up-to-seven Criteria: A Multicenter Case-matched Study. J Cancer 8:3506–3513

    Article  PubMed  PubMed Central  Google Scholar 

  30. Liu H, Wang ZG, Fu SY, et al. (2016) Randomized clinical trial of chemoembolization plus radiofrequency ablation versus partial hepatectomy for hepatocellular carcinoma within the Milan criteria. Br J Surg 103:348–356

    Article  CAS  PubMed  Google Scholar 

  31. Jin WK, Sang SS, Kim JK, et al. (2013) Radiofrequency Ablation Combined with Transcatheter Arterial Chemoembolization for the Treatment of Single Hepatocellular Carcinoma of 2 to 5 cm in Diameter: Comparison with Surgical Resection. Korean J Radiol 14:626–635

    Article  Google Scholar 

  32. Facciorusso A, Maso MD, Muscatiello N (2016) Microwave ablation versus radiofrequency ablation for the treatment of hepatocellular carcinoma: A systematic review and meta-analysis. International. Int J Hyperthermia 32:339–344

    Article  CAS  Google Scholar 

  33. Poggi G, Tosoratti N, Montagna B, et al. (2015) Microwave ablation of hepatocellular carcinoma. World J Hepatol 7:2578–2589

    Article  PubMed  PubMed Central  Google Scholar 

  34. Chen QF, Jia ZY, Yang ZQ, et al. (2017) Transarterial Chemoembolization Monotherapy Versus Combined Transarterial Chemoembolization-Microwave Ablation Therapy for Hepatocellular Carcinoma Tumors ≤ 5 cm: A Propensity Analysis at a Single Center. Cardiovasc Intervent Radiol 40:1748–1755

    Article  PubMed  Google Scholar 

  35. 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 28:456–463

    Article  CAS  PubMed  Google Scholar 

  36. Yi YX, Zhang YF, Wei Q, et al. (2014) Radiofrequency ablation or microwave ablation combined with transcatheter arterial chemoembolization in treatment of hepatocellular carcinoma by comparing with radiofrequency ablation alone. Chin J Cancer Res 26:112–118

    PubMed  PubMed Central  Google Scholar 

  37. Saini A, Wallace A, Alzubaidi S, et al. (2019) History and Evolution of Yttrium-90 Radioembolization for Hepatocellular Carcinoma. J Clin Med 8:55

    Article  PubMed Central  Google Scholar 

  38. Sangro B, Iñarrairaegui M, Bilbao JI (2012) Radioembolization for hepatocellular carcinoma. J Hepatol 56:464–473

    Article  PubMed  Google Scholar 

  39. Salem R, Gordon AC, Mouli S, et al. (2016) Y90 radioembolization significantly prolongs time to progression compared with chemoembolization in patients with hepatocellular carcinoma. Gastroenterology 151:1155–1163

    Article  PubMed  PubMed Central  Google Scholar 

  40. Riaz A, Gates VL, Atassi B, et al. (2011) Radiation segmentectomy: a novel approach to increase safety and efficacy of radioembolization. Int J Radiat Oncol Biol Phys 79:163–171

    Article  PubMed  Google Scholar 

  41. Biederman DM, Titano JJ, Bishay VL, et al. (2016) Radiation Segmentectomy versus TACE Combined with Microwave Ablation for Unresectable Solitary Hepatocellular Carcinoma Up to 3 cm: A Propensity Score Matching Study. Radiology 283:895–905

    Article  PubMed  Google Scholar 

  42. Vouche M, Lewandowski RJ, Atassi R, et al. (2013) Radiation Lobectomy: Time-Dependent Analysis of Future Liver Remnant Volume in Unresectable Liver Cancer as a Bridge to Resection. J Hepatol 59:1029–1036

    Article  PubMed  PubMed Central  Google Scholar 

  43. Abdelaziz AO, Abdelmaksoud AH, Nabeel MM, et al. (2017) Transarterial Chemoembolization Combined with Either Radiofrequency or Microwave Ablation in Management of Hepatocellular Carcinoma. Asian Pac J Cancer Prev 18:189–194

    PubMed  PubMed Central  Google Scholar 

  44. Vasnani R, Ginsburg M, Ahmed O, et al. (2016) Radiofrequency and microwave ablation in combination with transarterial chemoembolization induce equivalent histopathologic coagulation necrosis in hepatocellular carcinoma patients bridged to liver transplantation. Hepatobiliary Surg Nutr 5:225–233

    Article  PubMed  PubMed Central  Google Scholar 

  45. Song KD (2016) Percutaneous cryoablation for hepatocellular carcinoma. Clin Mol Hepatol 22:509–515

    Article  PubMed  PubMed Central  Google Scholar 

  46. Bageacu S, Kaczmarek D, Lacroix M, et al. (2007) Cryosurgery for resectable and unresectable hepatic metastases from colorectal cancer. Eur J Surg Oncol 33:590–596

    Article  CAS  PubMed  Google Scholar 

  47. Kerkar S, Carlin AM, Sohn RL, et al. (2004) Long-term follow up and prognostic factors for cryotherapy of malignant liver tumors. Surgery (St Louis) 136:770–779

    Article  Google Scholar 

  48. Seifert JK, Morris DL (1999) World survey on the complications of hepatic and prostate cryotherapy. World J Surg 23:109–113

    Article  CAS  PubMed  Google Scholar 

  49. Xu KC, Niu LZ, Zhou Q, et al. (2009) Sequential use of transarterial chemoembolization and percutaneous cryosurgery for hepatocellular carcinoma. World J Gastroenterol 15:3664–3669

    Article  PubMed  PubMed Central  Google Scholar 

  50. Huang KB, Fan WZ, Zhang YY, et al. (2016) Transarterial chemoembolization combined with cryoablation for unresectable large hepatocellular carcinoma: a controlled study. Zhonghua Yi Xue Za Zhi 96:2978–2982

    CAS  PubMed  Google Scholar 

  51. Huang C, Zhuang W, Feng H, et al. (2016) Analysis of therapeutic effectiveness and prognostic factor on argon-helium cryoablation combined with transcatheter arterial chemoembolization for the treatment of advanced hepatocellular carcinoma. J Cancer Res Ther 12:C148–C152

    Article  CAS  PubMed  Google Scholar 

  52. Huang M, Wang X, Huang B (2015) Effect of Transcatheter Arterial Chemoembolization Combined with Argon-Helium Cryosurgery System on the Changes of NK Cells and T Cell Subsets in Peripheral Blood of Hepatocellular Carcinoma Patients. Cell Biochem Biophys 73:787–792

    Article  CAS  PubMed  Google Scholar 

  53. Lencioni R, Crocetti L, Petruzzi P, et al. (2008) Doxorubicin-eluting bead-enhanced radiofrequency ablation of hepatocellular carcinoma: a pilot clinical study. J Hepatol 49:217–222

    Article  CAS  PubMed  Google Scholar 

  54. Feng YM, Wang X, Wang L, et al. (2017) Efficacy and safety of combination therapy of chemoembolization and radiofrequency ablation with different time intervals for hepatocellular carcinoma patients. Surg Oncol 26:236–241

    Article  PubMed  Google Scholar 

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Funding

This work was supported by the Innovative Team of Jiangsu Province (Grant No. 3101030420000606).

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Authors and Affiliations

  1. Department of Interventional Radiology, First Affiliated Hospital of Soochow University, 188 Shizi Street, 215006, Suzhou, Jiangsu, People’s Republic of China

    Wei Li & Cai-Fang Ni

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  1. Wei Li
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Correspondence to Cai-Fang Ni.

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Li, W., Ni, CF. Current status of the combination therapy of transarterial chemoembolization and local ablation for hepatocellular carcinoma. Abdom Radiol 44, 2268–2275 (2019). https://doi.org/10.1007/s00261-019-01943-2

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