Clinical

Adding radiofrequency ablation to chemoembolization ups liver cancer survival

Last Updated: 2008-04-08 17:21:50 -0400 (Reuters Health)

By Anthony J. Brown, MD

NEW YORK (Reuters Health) - As a treatment for hepatocellular carcinoma larger than 3 cm, transarterial chemoembolization (TACE) plus radiofrequency ablation (RFA) leads to better survival than either modality alone, according to a report in the Journal of the American Medical Association for April 9.

This is the first randomized controlled trial to compare TACE-RFA with TACE or RFA alone in patients with larger hepatocellular carcinomas, lead author Dr. Bao-Quan Cheng, from Shandong University in Jinan, China, told Reuters Health.

The study involved 291 consecutive patients seen at a single center in China who were randomized to receive one of the three treatments. The main end point was survival.

During a median follow-up period of 28.5 months, the median survival period in the TACE-RFA group was 37 months compared with 24 and 22 months in the TACE and RFA groups, respectively. Patients treated with TACE-RFA were about 88% more likely than those treated with TACE or RFA to survive (p < 0.001 for both).

On subgroup analysis, TACE-RFA was better than RFA in improving the survival of patients with uninodular carcinoma (p = 0.001) and superior to TACE in increasing the survival of those with multinodular disease (p < 0.001).

Overall, 54% of TACE-RFA-treated patients had an objective response rate that lasted at least 6 months. By contrast, the rates in the other groups did not exceed 36%.

Dr. Cheng said that further research is needed to determine if these findings apply to patients in countries other than China. The gastroenterologist explained that in China, hepatocellular carcinoma is typically due to hepatitis B virus, whereas in Western countries, hepatitis C virus, alcohol abuse, and other diseases are the main causes.

JAMA 2008;299:1669-1677.