Clinical

RF ablation plus chemoembolization comparable to surgery for early liver cancer

Last Updated: 2008-04-02 10:31:45 -0400 (Reuters Health)

By Anthony J. Brown, MD

NEW YORK (Reuters Health) - Radiofrequency ablation combined with chemoembolization provides comparable overall and disease-free survival as hepatectomy for early-stage hepatocellular carcinoma, Japanese investigators report.

In their study, the overall survival rate at 5 years was 75% with the combined treatment and 81% with surgery. The corresponding recurrence-free survival rates were also similar, 27% and 26%.

The findings suggest that "radiofrequency ablation combined with chemoembolization provides patients with early-stage hepatocellular carcinoma similar results to surgical intervention," lead author Dr. Koichiro Yamakado told Reuters Health. He added that his team is now planning to conduct a randomized trial to confirm this.

Surgical resection is considered the gold standard for treating early-stage disease, but only 9% to 29% of patients are eligible for this procedure either because of underlying pathology that limits their hepatic reserve or because tumor nodules are spread throughout the liver, according to the report in the April issue of Radiology.

In treating small hepatic tumors, radiofrequency ablation has been shown to achieve overall survival rates comparable to that of surgical resection, but it is associated with lower recurrence-free survival. Combining radiofrequency ablation with chemoembolization might solve this problem.

To investigate, Dr. Yamakado, from Mie University School of Medicine, and colleagues compared the survival outcomes of 104 patients treated with chemoembolization followed by radiofrequency ablation and 62 treated with hepatectomy. Eligibility criteria included no prior treatment for hepatocellular carcinoma, three or fewer tumors with a maximum diameter no greater than 3 cm or a single tumor no greater than 5 cm, Child-Pugh class A, no vascular invasion, and no extrahepatic metastases.

The 1- and 3-year overall survival rates with each treatment strategy were nearly identical, at 98% and 94%, respectively, in the combination therapy group, compared with 97% and 93% in the hepatectomy group. The corresponding recurrence-free survival rates were also similar with combination therapy (89% and 69%) and hepatectomy (92% and 64%).

The findings suggest that radiofrequency ablation plus chemoembolization is a suitable alternative to hepatectomy for early-stage disease, the authors conclude, but "a randomized controlled trial is warranted to clarify whether this combination therapy could provide the same results as hepatectomy over long-term periods."

Radiology 2008;247:260-266.