Researchers Compare Resection vs Radiofrequency Ablation Plus TACE

Radiofrequency ablation plus transcatheter arterial chemoembolization (TACE) may yield similar overall survival (OS) rates to liver resection in patients with cirrhosis and large, solitary hepatocellular carcinoma (HCC) tumors, researchers reported.

Liver resection remains the standard-of-care for patients with HCC ≥ 3 cm and who are not suited for transplantation, but liver function and contraindications to surgery may mean that resection is not feasible for all patients. To determine whether the combination of radiofrequency ablation and TACE is an effective and safe option, researchers conducted a prospective observational single-center pilot study that evaluated overall survival (OS) and tumor recurrence (TR) rate.

The study took place from 2010 to 2014 and included 25 patients with compensated cirrhosis and single HCC ≥ 3 cm who were not eligible for liver resection or transplantation. The 25 patients received radiofrequency ablation plus transarterial chemoembolization, with complete tumor necrosis achieved in all patients following treatment. A retrospective control group of 29 patients with HCC ≥ 3 cm were also included in the study; these patients underwent liver resection.

In the resection group, one patient died and there was one major complication, while no major complications occurred in the radiofrequency ablation plus TACE group. The researchers evaluated outcomes at 1 and 3 years following treatment for both groups.

“Liver resection achieved lower TR and local tumor progression rates than radiofrequency ablation plus transarterial chemoembolization, but 3-years OS rates were not statistically different between the 2 groups,” they stated.

One year after treatment, OS in the resection group was 91.3%, and 3 years after treatment, the OS was 79.3%. Among patients who received radiofrequency ablation and TACE, there was an OS of 89.4% at 1 year and 48.2% at 3 years.

At 1 and 3 years, TR rates were 29.5% and 45% in the resection group versus 42.4% and 76.0% in the radiofrequency ablation plus TACE group. Additionally, local tumor progression rates at 3 years were significantly lower in patients who underwent resection.

“When surgery is not feasible because of patient refusal, comorbidities, tumor location, or high risk of complications or death, an optimal treatment approach is not yet available. In this setting, radiofrequency ablation plus transarterial chemoembolization is a safe and effective option that needs further investigation in a larger number of patients,” the study’s authors concluded.

Reference

Salvanio A, Iezzi R, Guilante F, et al. Liver resection versus radiofrequency ablation plus transcatheter arterial chemoembolization in cirrhotic patients with solitary large hepatocellular carcinoma. J Vasc Interv Radiol. 28(11):1512-1519.