Repeated Radiofrequency Ablation Combined With Ablated Lesion Elimination and Transarterial Chemoembolization Improves the Outcome of Solitary Huge Hepatocellular Carcinomas 10 cm or Larger

Abstract

This study investigated the effectiveness of a new strategy, repeated radiofrequency (RF) ablation combined with ablated lesion elimination following transarterial chemoembolization (TACE)/transarterial embolization (TAE), for solitary huge hepatocellular carcinoma (SHHCC) 10 cm or larger.From July 2008 to October 2015, 39 consecutive patients with SHHCC were screened. Of these, 12 were treated with TACE/TAE and repeated RF ablation (TACE/TAE + RF ablation group) and the remaining 27 patients were treated with the aforementioned new strategy (new strategy group). Local tumor progression (LTP)-free survival, intrahepatic distant recurrence (IDR)-free survival, and overall survival (OS) rates were obtained using the Kaplan–Meier method. Univariate and multivariate analyses were performed on several clinicopathological variables to identify factors affecting long-term outcome and intrahepatic recurrence. Correlation analysis was also performed.The 1-, 2-, and 3-year LTP-free survival rates and OS rates were significantly higher in the new strategy group than in the TACE/TAE + RF ablation group (82.9% vs 58.3%, 73.9% vs 29.2%, 18.5% vs 9.7%, P = 0.002; 92.0% vs 75.0%, 84.0% vs 33.3%, 32.7% vs 16.7%, P = 0.025). However, there was no significant difference between the 2 groups in the 1-, 2-, and 3-year IDR-free survival rates (P = 0.108). Using univariate analysis, alpha-fetoprotein (AFP > 200 ng/mL), ablative margin (AM > 1.0 cm), and well-differentiated cells were found to be significant factors for predicting LTP, IDR, and OS. Surgical elimination was found to be a significant factor only for predicting OS. In multivariate analyses, AFP (>200 ng/mL), AM (>1.0 cm), and well-differentiated cells were found to be significant independent factors linked to LTP, IDR, and OS. Correlation analysis indicated that AM > 1.0 cm was strongly associated with surgical elimination (P < 0.001, correlation coefficient = 0.877).For patients with SHHCC who were initially excluded from surgery, the new strategy including repeated RF ablation combined with ablated lesion elimination following TACE/TAE should now be considered as an alternative treatment.

Transarterial chemoembolization combined with radiofrequency ablation in the treatment of large hepatocellular carcinoma with stage C

“…However, our results showed that HCC patients who received TACE-RFA on tumor diameters larger than 5 cm and even greater than 10 cm exhibited better OS than those who had only TACE. These are similar to Ke et al ’s clinical findings[ 22 ]. Hence, we should use RFA flexibly in patients with liver cancer after fully evaluating their condition, regardless of tumor size.…”

3D visualization ablation planning system assisted microwave ablation for hepatocellular carcinoma (Diameter >3): a precise clinical application

“…The clinical variables included tumor factors and therapeutic alliance. Several reports had pointed out TACE combined with MWA was safe and effective in the treatment of large HCC lesions [30][31][32]. Furthermore, the convenience of using nomogram derived from pretreatment clinical variables to assess prognosis for individual patients with HCC before initiation of treatment may improve patient-physician communication, decision making and selection of patients for prospective clinical trials.…”

Progression of hepatocellular carcinoma after radiofrequency ablation: Current status of research

“…( 92 ) also found that enlarging the ablation margin could significantly reduce the risk of tumor recurrence and improve the long-term survival rate. In a previous study, we demonstrated that repeated RFA with an ablation margin and transarterial chemoembolization improved the outcome in patients with large solitary HCCs measuring ≥10 cm ( 93 ). Moreover, our yet to be published current research demonstrates that long-term overall survival is not significantly different between anatomic resection and RFA with an ablation margin ≥1.0 cm in patients with a solitary HCC measuring ≤3 cm.…”