Study Compares RFA vs TACE for Caudate HCC

Patients with caudate hepatocellular carcinoma (HCC) within the Milan criteria may experience better results with radiofrequency ablation (RFA) than with transarterial chemoembolization (TACE), according to a study published in Cardiovascular and Interventional Radiology.

Although HCC in the caudate lobe is rare and difficult to treat from a technical standpoint, both RFA and TACE have areas of strength. However, thus far, no studies have compared outcomes for these modalities. To further investigate the performance of both modalities, researchers undertook a retrospective review of 74 patients with a single HCC ≤ 5 cm or up to three HCCs ≤ 3 cm without vascular invasion or extrahepatic metastasis. The caudate HCC in this study was within the Milan criteria. Between November 2005 and August 2016, 43 patients were treated with RFA and 31 were treated with TACE.

Patients were followed for a mean of 2.8 ± 1.9 years, and results showed 1-, 2-, and 3-year survival rates were 97.1%, 94.0%, and 80.7% for the RFA group. For the TACE group, 1-, 2-, and 3-year survival rates were 89.0%, 80.8%, and 62.0%. Propensity score adjustment was used to ensure that the clinical variables of the RFA and the TACE groups were well balanced. Results for both overall survival and for progression-free survival were better for the RFA group than the TACE group, the researchers noted.

Three patients in the RFA group had grade 3 complications, which included liver abscess, acute cholecystitis, and hepatic artery pseudoaneurysm. There were no cases of mortality related to RFA.

“Despite RFA involving more procedure-related complications, the clear survival benefits of RFA suggest that TACE should be reserved as only a salvage treatment for caudate HCC when liver transplantation, surgical resection, and echo-guided or CT-guided RFA are not suitable.”

Reference

Lee BC, Liu KL, Wu CH, et al. Comparison of Radiofrequency Ablation and Transarterial Chemoembolization for Hepatocellular Carcinoma in the Caudate Lobe. Cardiovasc Intervent Radiol. 2018 Jun 26. doi: 10.1007/s00270-018-1978-0. [Epub ahead of print].