Combination transarterial chemoembolization and microwave ablation improves local tumor control for 3- to 5-cm hepatocellular carcinoma when compared with transarterial chemoembolization alone

Smolock, Amanda R.; Cristescu, M.; Hinshaw, Audrey; Woo, Kaitlin M.; Wells, Shane A.; Ziemlewicz, Timothy J.; Lubner, Meghan G.; Dalvie, P.; Hinshaw, J. Louis; Brace, Christopher L.; Özkan, Orhan Ş.; Lee, Fred T.; Laeseke, Paul F.

doi:10.1007/s00261-018-1464-9

Cited by 37 publications

(31 citation statements)

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“…Consistent with previously studies, our analysis demonstrates that an add‐on resection or ablation after initial TACE significantly extended the survival time and increased the percentage of patients who reached a 3‐year survival time . This suggests that add‐on resection/ablation works synergistically with TACE.…”

Section: Discussionsupporting

confidence: 90%

“…In addition, the add-on resection or ablation removes or necrotizes hypovascular HCC lesions that are refractory to cytotoxicity by TACE delivered chemicals. 57,58 In further analysis, vascular invasion was the only risk factor that compromised the long-term survival in patients who received the add-on resection and/or ablation after TACE. This finding reveals that the efficacy of the add-on resection and/ or ablation is effective in eliminating almost all of the factors that are required to achieve the 3-year survival in the group without resection and/or ablation after TACE.…”

Section: Discussionmentioning

confidence: 97%

“…TACE reduces or stabilizes the size of large HCCs and induces ischemia and inflammatory edema in tumor tissues, which provide favorable conditions for the success of add‐on resection or ablation treatment. In addition, the add‐on resection or ablation removes or necrotizes hypovascular HCC lesions that are refractory to cytotoxicity by TACE delivered chemicals …”

Section: Discussionmentioning

confidence: 99%

“…Consistent with previously studies, our analysis demonstrates that an add-on resection or ablation after initial TACE significantly extended the survival time and increased the percentage of patients who reached a 3-year survival time. [56][57][58][59] This suggests that add-on resection/ ablation works synergistically with TACE. TACE reduces or stabilizes the size of large HCCs and induces ischemia and inflammatory edema in tumor tissues, which provide favorable conditions for the success of add-on resection or ablation treatment.…”

Section: Discussionmentioning

confidence: 99%

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Clinical conditions and treatment requirements for long‐term survival among hepatitis B‐related hepatocellular carcinoma initially treated with chemoembolization

Chen

Jian

et al. 2019

Cancer Medicine

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Objective Transarterial chemoembolization (TACE) is recommended to treat intermediate/advanced stage of hepatocellular carcinoma (HCC). However, the overall survival among initially TACE‐treated patients varies significantly. The clinical characterization of long‐term survival following TACE remains uncertain. We sought to identify clinical parameters and treatment requirements for long‐term survival among patients with hepatitis B‐related HCC who were initially treated with TACE. Materials and Methods The included patients with HCC were admitted to our cancer center between December 2009 and May 2015. Patients who survived for >3 years were compared with those who died within 3 years. The clinical and laboratory findings that were associated with the survival were also analyzed. Results One in six (17.9%) patients with HCC in this cohort survived for > 3 years after TACE. Body mass index (BMI) ≥ 23kg/m 2 , aspartate aminotransferase levels ≤ 40 U/L, an activated partial thromboplastin time ≤ 34 seconds, α‐fetoprotein (AFP) levels ≤ 25 ng/mL, antiviral therapy, tumor size ≤ 8 cm, solitary nodule, and the absence of vascular invasion were independently favorably associated with a 3‐year survival. An absence of vascular invasion was the only independent factor associated with 3‐year survival in patients who received resection and/or ablation after TACE. Conclusion In this cohort, a 3‐year survival was associated with BMI, antivirus treatment, tumor status, hepatic function, and AFP level. Distant metastasis did not negatively impact the long‐term survival among patients with hepatitis B‐related HCC initially treated with TACE. Vascular invasion was the single impediment to long‐term survival in patients who received add‐on resection and/or ablation after TACE.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Clinical conditions and treatment requirements for long‐term survival among hepatitis B‐related hepatocellular carcinoma initially treated with chemoembolization

Chen

Jian

et al. 2019

Cancer Medicine

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“…Previous studies reported that TACE combined with MWA (TACE-MWA) was associated with several advantages in patients with unresectable HCC. [44][45][46] Firstly, liver dysfunction was a risk prognostic factor of long-term survival in HCC patients. It was previously shown that sustained TACE treatment was more likely to cause liver failure than the other local treatments or systemic treatments.…”

Section: Discussionmentioning

confidence: 99%

<p>Transarterial Chemoembolization and Sorafenib Combined with Microwave Ablation for Advanced Primary Hepatocellular Carcinoma: A Preliminary Investigation of Safety and Efficacy</p>

Ni¹,

Sun²,

Luo³

et al. 2019

CMAR

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The aim of this study was to investigate the safety and efficacy of transarterial chemoembolization and sorafenib (TACE-S) combined with microwave ablation (TACE-S-MWA) for the treatment of patients with advanced primary hepatocellular carcinoma (HCC). Methods: Between January 2015 and December 2018, 152 consecutive advanced HCC patients, who underwent TACE-S-MWA (MWA group, n=77) or TACE-S (Non-MWA group, n=75), were investigated. Overall survival (OS), time to progression (TTP) and safety were compared between the two groups. Prognostic factors were analyzed using the Cox proportional hazard regression model. Results: Baseline patient characteristics were balanced between the two groups. MWA group was associated with a higher OS (median, 19.0 vs 13.0 months; P<0.001) and a longer TTP (median, 6.0 vs 3.0 months; P<0.001) compared with non-MWA group. Multivariate analyses showed that portal vein tumor thrombosis (PVTT) (P=0.002), duration of sorafenib (P<0.001), and MWA treatment (P=0.011) were independently associated with OS. MWA treatment strategy (P<0.001) was a significant predictor of TTP. There were no treatment-related mortalities in either group. The rates of minor complications (42.9% vs 38.7%, P=0.599) and major complications (1.29% vs 1.33%, P=0.985) in the MWA group were similar to those in the non-MWA group. Conclusion: TACE-S-MWA was safe and effective for advanced primary HCC. TACE-S-MWA resulted in better OS and TTP than did TACE-S for treatment of patients with advanced primary HCC.

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Association of Addition of Ablative Therapy Following Transarterial Chemoembolization With Survival Rates in Patients With Hepatocellular Carcinoma

et al. 2020

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IMPORTANCE Hepatocellular carcinoma (HCC) is a heterogeneous disease with many available treatment modalities. Transarterial chemoembolization (TACE) is a valuable treatment modality for HCC lesions. This article seeks to evaluate the utility of additional ablative therapy in the management of patients with HCC who received an initial TACE procedure. OBJECTIVE To compare the overall survival (OS) and freedom from local progression (FFLP) outcomes after TACE alone with TACE that is followed by an ablative treatment regimen using stereotactic body radiation therapy, radiofrequency ablation, or microwave ablation for patients with HCC. DESIGN, SETTING, AND PARTICIPANTS This cohort study of 289 adults at a single urban medical center examined survival outcomes for patients with nonmetastatic, unresectable HCC who received ablative therapies following TACE or TACE alone from January 2010 through December 2018. The Lee, Wei, Amato common baseline hazard model was applied for within-patient correlation with robust variance and Cox regression analysis was used to assess the association between treatment group (TACE vs TACE and ablative therapy) and failure time events (FFLP per individual lesion and OS per patient), respectively. In both analyses, the treatment indication was modeled as a time-varying covariate. Landmark analysis was used as a further sensitivity test for bias by treatment indication. EXPOSURES TACE alone vs TACE followed by ablative therapy. MAIN OUTCOMES AND MEASURES Freedom from local progression and overall survival. Hypotheses were generated before data collection. RESULTS Of the 289 patients identified, 176 (60.9%) received TACE only and 113 (39.1%) received TACE plus ablative therapy. Ablative therapy included 45 patients receiving stereotactic body radiation therapy, 39 receiving microwave ablation, 20 receiving radiofrequency ablation, and 9 receiving a combination of these following TACE. With a median (interquartile range) follow-up of 17.4 (9.5-29.5) months, 242 of 512 (47.3%) lesions progressed, 211 in the group with TACE alone and 31 in the group with TACE plus ablative therapy (P < .001). Over 3 years, FFLP was 28.1% for TACE alone vs 67.4% for TACE with ablative therapy (P < .001). The 1-year and 3-year OS was 87.5% and 47.1% for patients with lesions treated with TACE alone vs 98.7% and 85.3% for patients where any lesion received TACE plus ablative therapy, respectively (P = .01), and this benefit remained robust on landmark analyses at 6 and 12 months. The addition of ablative therapy was independently associated with OS on multivariable analysis for all patients (hazard ratio, 0.26; 95% CI, 0.13-0.49; (continued) Key Points Question Is the addition of ablative treatment using stereotactic body radiation therapy, radiofrequency ablation, or microwave ablation to transarterial chemoembolization associated with improved treatment outcomes and survival for patients with hepatocellular carcinoma (HCC)? Findings In this cohort study of 289 patients with HCC, the addition of ablative therapy...

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Combination transarterial chemoembolization and microwave ablation improves local tumor control for 3- to 5-cm hepatocellular carcinoma when compared with transarterial chemoembolization alone

Abstract: Combination therapy with TACE and microwave ablation improves local control and increases time to LTP for 3-5 cm HCC.

Cited by 37 publications

References 23 publications

Clinical conditions and treatment requirements for long‐term survival among hepatitis B‐related hepatocellular carcinoma initially treated with chemoembolization

Clinical conditions and treatment requirements for long‐term survival among hepatitis B‐related hepatocellular carcinoma initially treated with chemoembolization

<p>Transarterial Chemoembolization and Sorafenib Combined with Microwave Ablation for Advanced Primary Hepatocellular Carcinoma: A Preliminary Investigation of Safety and Efficacy</p>

Association of Addition of Ablative Therapy Following Transarterial Chemoembolization With Survival Rates in Patients With Hepatocellular Carcinoma

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