Abstract No. 109: Combined chemoembolization and radiofrequency ablation for intermediate-size primary and secondary hepatic malignancies

Abstract

To evaluate local control, time to progression, and survival after combined chemoembolization and radiofrequency ablation (RFA) in patients with intermediate-sized primary and secondary hepatic malignancies. Patient records were reviewed retrospectively with IRB approval. 68 tumors (44 primary, 24 metastatic) in 57 patients were chemoembolized followed by RFA the next day. Mean tumor diameter was 4.6 cm (maximum 9.2 cm). 58/68 tumors were treated with LeVeen probes, 7 with RITA, and 3 with Radionics. Clinical, laboratory, and imaging evaluations were performed one month post-treatment then every 3 months. Response was assessed by EASL criteria, survival analysis by Kaplan-Meier estimates, censoring for transplantation. Patients who neither received a transplant nor died were followed for a median of 16.4 months (range 1-114). Among 59/68 tumors evaluable by imaging for response, residual viable tumor was detected in 10/59 (17%) tumors in 10 patients: 6 at 1 month, 1 at 2 months, 1 at 4 months, 1 at 7 months and 1 at 13 months. These included 5/38 (13%) primary tumors and 5/21 (24%) metastases. Local failures occurred in 0/9 tumors <3cm, 5/24 (21%) 3-5cm, and 5/26 (19%) greater than 5cm. Kaplan-Meier estimated 1-year freedom from local progression was 82% for primary and 71% for metastatic tumors. Among the 49 patients with follow-up imaging, 31/49 (63%) patients progressed at sites other than the treated lesion; 52% of patients with primary tumors and 88% of patients with metastases. 10 patients were censored at the time of transplantation. Kaplan-Meier estimated 1-year progression-free survival was 42% (median, 10 mo) for patients with primary tumors and 24% (median, 2.6 mo) for patients with metastases. Overall survival 1-year from therapy was 59% (median, 19.5 mo) for patients with primary tumors and 28% (median, 9.1 mo) for patients with metastases. Chemoembolization with RFA achieved complete response by EASL criteria in 83% of liver tumors up to 9.2 cm in diameter. Despite this, progression elsewhere remains a major determinant of survival, stressing the need for integration of effective systemic therapies.