Comparison of Combination Therapies in the Management of Hepatocellular Carcinoma: Transarterial Chemoembolization with Radiofrequency Ablation versus Microwave Ablation

Abstract

Purpose To compare retrospectively the outcomes and complications of transcatheter arterial chemoembolization with drug-eluting embolic agents combined with radiofrequency (RF) ablation or microwave (MW) ablation in treatment of hepatocellular carcinoma (HCC). Materials and Methods From 2003–2011, 89 patients with HCC received a combination therapy—transcatheter arterial chemoembolization plus RF ablation in 38 patients and transcatheter arterial chemoembolization plus MW ablation in 51 patients. Local tumor response, tumor progression-free survival (PFS), overall PFS, overall survival (OS), and complications were compared. Overall PFS and OS were compared between the two treatment groups in multivariate analysis controlling for Child-Pugh class, Barcelona Clinic Liver Classification stage, and index tumor size. Results Complete local tumor response was achieved in 37 (80.4%) of the tumors treated with transcatheter arterial chemoembolization plus RF ablation and 49 (76.6%) of the tumors treated with transcatheter arterial chemoembolization plus MW ablation (P = .67). The median tumor PFS and overall PFS were 20.8 months and 9.3 months (P = .72) for transarterial chemoembolization plus RF ablation and 21.8 months and 9.2 months for transarterial chemoembolization plus MW ablation (P = .32). The median OS of the transcatheter arterial chemoembolization plus RF ablation group was 23.3 months, and the median OS of the transcatheter arterial chemoembolization plus MW ablation group was 42.6 months, with no significant difference in the survival experience between the two groups (log-rank test, P = .10). In the multivariate analysis, Barcelona Clinic Liver Classification stage was the only factor associated with overall PFS and OS. One patient in the transcatheter arterial chemoembolization plus RF ablation cohort (3%) and two patients in the transcatheter arterial chemoembolization plus MW ablation cohort (4%) required prolonged hospitalization (< 48 h) for pain management after the procedure (P = 1.00). Conclusions Based on similar safety and efficacy outcomes, both combination therapies, transcatheter arterial chemoembolization plus RF ablation and transcatheter arterial chemoembolization plus MW ablation, are effective treatments for HCC.

Radiofrequency vs Microwave Ablation After Neoadjuvant Transarterial Bland and Drug-Eluting Microsphere Chembolization for the Treatment of Hepatocellular Carcinoma

“…Virk et al retrospectively demonstrated similar marginally superior results with respect to initial response and local recurrence in those treated with MWA ablation and neoadjuvant TACE (25). Ginsburg et al showed comparable initial local response and progression free survival in their retrospectively analyzed RFA/TACE and MWA/TACE cohorts (26). Both studies reinforce our central hypothesis that MWA is at least as effective as RFA and should be given credence in the national guidelines.…”

Microwave ablation in primary and secondary liver tumours: technical and clinical approaches

“…There are limited data comparing different combined embolization and ablation strategies. One recent study showed similar safety and efficacy when comparing TACE-RF and TACE-MW for the treatment of HCC (43). …”

The Evolving Role of Local Treatments for HCC in the Third Millennium

“…The 1-, 3-, and 5-year disease-free survival rates were 70.5%, 42.3%, and 34.2%, respectively, for the RFA group and 62.3%, 33.8%, and 20.8% for the microwave ablation group; even in this case no statistically significant difference was noted. Interestingly, for the subgroup of patients with tumor diameters of 3.1-5.0 cm, the disease-free survival curve for the RFA-treated group was (33). Eighty-nine patients with HCC received TACE plus RFA (38 patients) or TACE plus microwave ablation (51 patients), without any statistically significant difference between the two groups in patient demographics, including age, sex, and etiology of liver cirrhosis, and no significant difference in tumor characteristics, including tumor size, number of tumors, and BCLC staging.…”