Radiofrequency ablation following first-line transarterial chemoembolization for patients with unresectable hepatocellular carcinoma beyond the Milan criteria
BMC Gastroenterology
Radiofrequency ablation following first-line transarterial chemoembolization for patients with unresectable hepatocellular carcinoma beyond the Milan criteria
Lan Zhang 0 1
Xin Yin 0 1
Yu-hong Gan 0 1
Bo-heng Zhang 0 1
Ju-bo Zhang 0 1
Yi Chen 0 1
Xiao-ying Xie 0 1
Ning-lin Ge 0 1
Yan-hong Wang 0 1
Sheng-long Ye 0 1
Zheng-gang Ren 0 1
0 Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education , 136 Xue Yuan Road, Shanghai 200032 , China
1 Liver Cancer Institute, Zhongshan Hospital, Fudan University , 136 Xue Yuan Road, Shanghai 20032 , China
Background: Recent studies suggest that a combination of radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) may have theoretical advantages over TACE alone for treatment of hepatocellular carcinoma (HCC). The purpose of this study was to evaluate the effectiveness and safety of radiofrequency ablation following first-line TACE treatment in the management of HCC beyond the Milan Criteria. Methods: Forty-five patients who consecutively underwent RFA following first-line TACE treatment for HCC beyond the Milan criteria were enrolled in this study. RFA was performed within 1-2 months after TACE treatment in patients who had incomplete necrotic tumor nodules. Primary effectiveness, complications, survival rates, and prognostic factors were evaluated retrospectively. Results: Complete ablation was achieved in 76.2% of the lesions according to 1-month follow-up computed tomography/magnetic resonance imaging evaluation. The mean follow-up period was 30.9 months (range 3-94 months). There were no major complications after RFA therapy. The median overall survival was 29 months (range 20-38 months), with 1-, 2-, and 3-year survival of 89%, 61%, and 43%, respectively. Multivariate analysis revealed that tumor diameter (P = 0.045, hazard ratio [HR] = 0.228, 95% confidence interval [CI]: 0.054-0.968) and pretreatment serum alpha-fetoprotein level (P = 0.024, HR = 2.239, 95% CI: 1.114-4.500) were independent predictors for long-term survival. Conclusions: HCC beyond the Milan criteria can be completely and safely ablated by radiofrequency ablation following first-line TACE treatment with a low rate of complications and favorable survival outcome. Further assessment of the survival benefits of combination treatment for HCCs beyond the Milan Criteria is warranted.
Hepatocellular carcinoma; Radiofrequency ablation; Transcatheter arterial chemoembolization; Milan criteria
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Background
Hepatocellular carcinoma (HCC) is the third most common
cause of cancer-related mortality worldwide and the second
most common in China [1,2]. Despite increased early
diagnosis of HCC as a result of surveillance of high-risk
populations, only 30% of patients diagnosed with early
stage HCC are candidates for curative therapies such as
surgical resection or radiofrequency ablation [3]. Moreover,
the prognosis of patients with advanced or unresectable
HCC remains unsatisfactory due to a low response rate and
short time to progression. According to current treatment
guidelines, transcatheter arterial chemoembolization (TACE)
has been established as the standard therapy for patients
who are not eligible for curative therapies [4,5]. Although
the survival benefit of TACE treatment has been proved
in two randomized clinical trials [5,6], TACE has a
primarily palliative effect and does not achieve complete
tumor necrosis therefore tumor relapse after TACE is
universal [7]. Additionally, repetitive TACE treatments
might damage liver function reserve and decrease survival
time. Consequently, new strategies are needed to improve
the effectiveness of TACE treatment for HCC patients.
Percutaneous radiofrequency ablation (RFA) has been
accepted as a curative therapy for small HCC, and can
provide better local control of the disease than TACE
treatment and a similar long-term survival to surgical
resection. Previous studies have shown that RFA can
achieve complete necrosis in more than 90% of small
HCCs [8-10]. Nevertheless, the effectiveness of RFA
treatment in patients with intermediate or large HCC
is unsatisfactory, with a relatively low complete necrosis
rate ranging from 29.0% to 70.0% even if overlapping
ablation or repeated procedures are used [11-13].
Therefore, conventional RFA treatment was recommended
only for patients with small HCCs confined to the Milan
criteria [14].
Recent evidence has suggested that TACE combined
with RFA may have a synergistic effect on ablation of HCC
[15-17]. To date, few studies have investigated combination
therapy of radiofrequency ablation following transarterial
arterial chemoembolization for patients with unresectable
HCC beyond the Milan criteria. The aim of this study was
to evaluate the effectiveness and safety of such combination
therapy for unresectable HCC.
Methods
Patient enrollment
This survey is a retrospective study in a single center. The
TACE or RFA treatment procedures were accord (...truncated)