TACE, plus radiofrequency ablation, was superior to RFA alone in patients with liver-confined disease.

For patients with liver-limited, nonresectable hepatocellular cancer (HCC), treatment options include alcohol injection, radiofrequency ablation (RFA), and transcatheter arterial catheter embolization (TACE), with or without chemotherapy. However, the optimal therapy has not been clearly defined.

Now, Chinese investigators have conducted a single-institution, randomized trial to compare RFA, with or without TACE, in HCC patients with a solitary liver lesion 7 cm in size (or 3 lesions, each 3 cm in size), Child’s Pugh A or B liver disease, and no evidence of hepatic or portal venous invasion. All patients received RFA (up to 3 applications per session; an additional session was permitted if imaging indicated persistent viable tumor). For patients who received RFA plus TACE, hepatic artery infusion chemotherapy with carboplatin (300 mg) was followed by embolization with lipiodol (5 mL), epirubicin (50 mg), and mitomycin (8 mg) followed within 2 weeks by RFA. Of the nearly 2300 patients screened, 189 were treated. Most were male (89%) and positive for hepatitis B surface antigen (89%), and most had Child’s Pugh A liver disease (95%) and a solitary liver lesion (68%).

Recurrence rates trended lower with TACE plus RFA compared with RFA alone (35.1% and 54.7%, respectively). Overall survival (OS; the primary endpoint) was significantly better with TACE plus RFA (hazard ratio, 0.525; P=0.002; 4-year OS rates, 61.8% vs. 45.0%). Recurrence-free survival (RFS) was also significantly better with TACE plus RFA (HR 0.575; P=0.009; 4-year RFS rates, 54.8% vs. 38.9%). Complication rates were similar in the two therapy arms.

Comment: These results support the combination of RFA and chemoembolization for selected patients with liver-confined HCC. Issues remaining to be resolved include the role of chemotherapy added to embolization compared with embolization alone. The large degree of patient exclusion after screening, the relatively small number of patients treated, and the conduction of the trial at a single institution call into question the extent to which the findings can be generalized.

Source: Journal Watch Oncology and Hematology