Hepatocellular carcinomas 2-3 cm in diameter: transarterial chemoembolization plus radiofrequency ablation vs. radiofrequency ablation alone.
ABSTRACT There is debate whether transarterial chemoembolization (TACE) plus radiofrequency ablation (RFA) is more effective than RFA alone in the treatment of patients with small hepatocellular carcinoma (HCC). We therefore retrospectively compared these treatments in patients with HCCs of diameter 2-3 cm.
Outcomes, including tumor progression, survival rates, and major complications, were compared in 83 patients (83 tumors) treated with combined TACE and RFA and in 231 patients (231 tumors) treated with RFA alone.
Median follow-up periods were similar in the TACE+RFA and RFA alone groups (37 vs. 38 months). During follow-up, local tumor progression was observed in 16% and 41% of tumors, respectively. The 1, 3, and 5 year local tumor progression-free survival rates were significantly higher in the TACE+RFA group (95%, 86%, and 83%, respectively) than in the RFA-alone group (78%, 61%, and 53%, respectively; P<0.001). The 1, 3, and 5 year overall survival rates, however, were similar in the TACE+RFA (93%, 72%, and 63%, respectively) and RFA (93%, 73%, and 53%, respectively) groups (P=0.545), as were the rates of major complications (1.2% vs. 0.4%).
Combined TACE and RFA was safe and provided better local tumor control than RFA alone in the treatment of 2- to 3-cm sized HCCs, although survival rates were similar.
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ABSTRACT: PURPOSE: This meta-analysis was designed to compare the effectiveness of the combination of transarterial chemoembolization (TACE) and percutaneous radiofrequency ablation (PRFA) with that of TACE and PRFA monotherapy in hepatocellular carcinoma (HCC). METHODS: Randomized controlled trials were searched using various databases, and six studies were revealed on comparing TACE plus PRFA with TACE and/or PRFA alone for the treatment for HCC. Overall survival rate and recurrence-free survival rate were analyzed and compared. All statistic analyses were conducted using Review Manager (version 4.2.2.) from the Cochrane collaboration. RESULTS: Meta-analysis data revealed that TACE plus PRFA had significantly better effectiveness on 1- and 3-year overall survival rate(odds ratio [OR] 1-year = 4.61, 95 % confidence interval [95 % CI] 2.26-9.42, P < 0.0001; OR 3-year = 2.79, 95 % CI 1.69-4.61, P < 0.0001) and 3-year recurrence-free survival rate ([OR] 3-year = 3.00, [95 % CI] 1.75-5.13, P < 0.0001) than that of TACE and/or PRFA alone treatment. There was no significant difference between the combined therapy and monotherapy on 1-year recurrence-free survival rate ([OR] 1-year = 1.55, [95 % CI] 0.91-2.65, P = 0.11). CONCLUSIONS: The data of our study indicate that the combination of TACE and PRFA has better effectiveness than that of TACE and PRFA monotherapy in the treatment for patients with HCC.Journal of Cancer Research and Clinical Oncology 01/2013; · 2.91 Impact Factor
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ABSTRACT: To compare radiofrequency ablation (RFA) and transcatheter arterial chemoembolization (TACE) with RFA monotherapy in hepatocellular carcinoma (HCC). We searched PubMed, Medline, Embase and Chinese databases (CBMdisc and Wanfang data) for randomized controlled trails comparing RFA plus TACE and RFA alone for treatment of HCC from January 2000 to December 2012. The overall survival rate, recurrence-free survival rate, tumor progression rate, and safety were analyzed and compared. The analysis was conducted on dichotomous outcomes and the standard meta-analytical techniques were used. Pooled odds ratios (ORs) with 95%CIs were calculated using either the fixed-effects or random-effects model. For each meta-analysis, the χ(2) and I(2) tests were first calculated to assess the heterogeneity of the included trials. For P < 0.05 and I(2) > 50%, the assumption of homogeneity was deemed invalid, and the random-effects model was used; otherwise, data were assessed using the fixed-effects model. All statistical analysis was conducted using Review manager (version 4.2.2.) from the Cochrane collaboration. Eight randomized controlled trials were identified as eligible for inclusion in this analysis and included 598 patients with 306 treated with RFA plus TACE and 292 with RFA alone. Our data analysis indicated that RFA plus TACE was associated a significantly higher overall survival rate (OR1-year = 2.96, 95%CI: 1.84-7.74, P < 0.001; OR2-year = 3.72, 95%CI: 1.24-11.16, P = 0.02; OR3-year = 2.65, 95%CI: 1.81-3.86, P < 0.001) and recurrence-free survival rate (OR3-year = 3.00, 95%CI: 1.75-5.13, P < 0.001; OR5-year = 2.26, 95%CI: 1.43-3.57, P = 0.0004) vs that of RFA alone. The tumor progression rate in patients treated with RFA alone was higher than that of RFA plus TACE (OR = 0.60, 95%CI: 0.42-0.88, P = 0.008) and there was no significant difference on major complications between two different kinds of treatment (OR = 1.20, 95%CI: 0.31-4.62, P = 0.79). Additionally, the meta-analysis data of subgroups revealed that the survival rate was significantly higher in patients with intermediate- and large-size HCC underwent RFA plus TACE than in those underwent RFA monotherapy; however, there was no significant difference between RFA plus TACE and RFA on survival rate for small HCC. The combination of RFA with TACE has advantages in improving overall survival rate, and provides better prognosis for patients with intermediate- and large-size HCC.World Journal of Gastroenterology 06/2013; 19(24):3872-82. · 2.55 Impact Factor
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ABSTRACT: To compare the effectiveness of radiofrequency ablation (RFA) combined with transcatheter arterial chemoembolization (TACE) with surgical resection in patients with a single hepatocellular carcinoma (HCC) ranging from 2 to 5 cm. The study participants were enrolled over a period of 29 months and were comprised of 37 patients in a combined therapy group and 47 patients in a surgical resection group. RFA was performed the day after TACE, and surgical resection was performed by open laparotomy. The two groups were compared with respect to the length of hospital stay, rates of major complication, and rates of recurrence-free and overall survival. Major complications occurred more frequently in the surgical resection group (14.9%) than in the combined therapy group (2.7%). However, there was no statistical significance (p = 0.059). The rates of recurrence-free survival at 1, 2, 3 and 4 years were similar between the combined therapy group (89.2%, 75.2%, 69.4% and 69.4%, respectively) and the surgical resection group (81.8%, 68.5%, 68.5% and 65%, respectively) (p = 0.7962, log-rank test). The overall survival rates at 1, 2, 3 and 4 years were also similar between groups (97.3%, 86.5%, 78.4% and 78.4%, respectively, in the combined therapy group, and 95.7%, 89.4%, 84.3% and 80.3%, respectively, in the surgical resection group) (p = 0.6321, log-rank test). When compared with surgical resection for the treatment of a single HCC ranging from 2 to 5 cm, RFA combined with TACE shows similar results in terms of recurrence-free and overall survival rates.Korean journal of radiology: official journal of the Korean Radiological Society 07/2013; 14(4):626-35. · 1.32 Impact Factor