Reuters Health Information (2012-12-27): RFA with arterial chemoembolization improves hepatoma survival
RFA with arterial chemoembolization improves hepatoma survival
Last Updated: 2012-12-27 13:24:11 -0400 (Reuters Health)
NEW YORK (Reuters Health) - In patients with hepatocellular carcinoma, transcatheter arterial chemoembolization before radiofrequency ablation improved survival in a randomized trial, Chinese researchers say.
Although transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA) are each effective for early HCC, neither will adequately control medium or large HCC -- making their combined use appealing, Dr. Min-Shan Chen from Sun Yat-Sen University in Guangzhou and colleagues say in a report online December 26 in the Journal of Clinical Oncology.
TACE decreases blood flow to the tumor, they add, making subsequent RFA more effective
Dr. Koichiro Yamakado from Mie University School of Medicine, Mie, Japan has published widely on treatment of HCC. Dr. Yamakado, who was not involved in the Chinese study, told Reuters Health, "This paper is what I have been waiting for. Perhaps everybody has known that combination therapy is superior to RFA alone. This research is significant because it has shown the evidence."
The researchers compared long-term survival after treatment with TACE-RFA or RFA alone in a randomized trial of 189 patients with a solitary HCC no greater than 7 cm or up to three smaller HCC, each no greater than 3 cm.
Technical success of RFA was achieved in 91 of 94 patients in the TACE-RFA group and 92 of 95 patients in the RFA-only group.
After a median follow-up of 36 months, there was no significant difference in intrahepatic recurrence rates: 35.1% with TACE-RFA and 54.7% with RFA.
But overall survival was better in the TACE-RFA group (p=0.002) at one year (92.6% vs 85.3%), three years (66.6% vs 59.0%), and four years (61.8% vs 45.0%).
TACE-RFA patients also had better recurrence-free survival (p=0.009) at one year (79.4% vs 66.7%), three years (60.6% vs 44.2%), and four years (54.8% vs 38.9%).
Independent predictors of overall survival included treatment allocation, tumor size, and tumor number. Tumor number and treatment allocation also significantly predicted recurrence-free survival.
Significant complications included bile duct stenosis and gastric hemorrhage in the TACE-RFA group and abdominal infection and small intestinal obstruction in the RFA group. There were no treatment-related deaths.
"The future standard of care for HCC treatable with RFA should shift toward the combination treatment," the investigators conclude.
"The study also provides evidence that altering the tumor microenvironment and supporting vasculature may help improve the efficacy of locoregional therapy in HCC," the authors say.
Needed next, they add, are studies of complementary therapies, "such as targeted agents in combination with TACE-RFA."
In the meantime, Dr. Yamakado said, "The reduced local tumor progression rate after combination therapy may lead to less cost because the cost of interventional radiologic treatment of HCC largely depends on the number of repeat procedures required."
"Now that good local control is achieved by combination therapy, additional use of sorafenib may be a next step to reduce multifocal recurrence and provide better survival," Dr. Yamakado said.
In an editorial, Dr. Andrew X. Zhu from Harvard Medical School in Boston and Dr. Riad Salem from Northwestern University in Chicago write, "Combining RFA and TACE can theoretically overcome the limitations of each when used alone. This study provides the rationale, safety profile, and early evidence of improved survival that lends support for conducting additional clinical trials to assess the indication and value of combined TACE-RFA."
Neither Dr. Chen nor Dr. Zhu responded to a request for comments about this research.
J Clin Oncol 2012.