Endoarterial Treatment in Combination With Percutaneous Thermoablation for Medium-sized and Oligonodular Hepatocellular Carcinomas

Abstract

Background & Aims: The association of transcatheter arterial chemotherapy infusion (TAC) with percutaneous ablation (PT) has been introduced as a method to increase the size of the ablative zone and treat satellites micronodules. The aim of this study was to evaluate the efficacy of PT and TAC performed in a single session for hepatocellular carcinomas (HCCs) between 30 and 50 mm or oligonodular HCC up to 30 mm. Methods: Thirty patients with a histologically proven HCC, uninodular between 30 and 50 mm or oligonodular (n≤3) up to 30 mm, treatment-naive and non-metastatic, received the combination treatment (“PT+TAC group”). A “control” group consisted of 34 patients with uninodular HCC up to 30 mm without any poor prognostic criteria treated with PT alone (“PT group”). Results: The majority of patients were cirrhotic (90% vs 91%, respectively for the PT+TAC and PT groups), Child-Pugh A (83% vs 85%), with a Performans Status of 0 (80% vs 79%). There was no significant difference in the median alpha-fetoprotein level (15 vs 9.3 μg/l, p=0.39). The 1-, 3-, and 5-year OS was no significantly different in both groups: 100%, 82% and 48.5% in the PT+TAC group vs 94.1%, 72.7% and 65.2% in the PT group (p=0.88). The 1-, 3-, and 5-year relapse-free survival was significantly lower in the PT+TAC group: 59.3%, 18.5% and 5.6% vs 89.3%, 46.4% and 24.5%, in the PT group (p=0.02). Conclusion: The combination treatment for HCC between 30 and 50 mm or oligonodular up to 30 mm, showed a similar OS, compared to uninodular HCC up to 30 mm without poor prognostic criteria, treated with PT alone, at the price of earlier tumor recurrence.