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Abstract
BackgroundLimited therapies are available for large (≥40 mm) unresectable hepatocellular carcinoma (HCC). Currently, the standard treatment with transarterial chemoembolisation (TACE) is unsatisfactory with high recurrence rate and limited effect on survival. Laser Ablation (LA) has emerged as a relatively new technique characterized by high efficacy and good safety. This study is aimed to evaluate the efficacy of LA in comparison to TACE in patients with large HCC.MethodsEighty-two patients with a single HCC nodule ≥40 mm (BCLC stage A or B) were enrolled in this case-control study. Forty-one patients were treated with LA and 41 patients were treated with TACE. Response to therapy was evaluated according to the mRECIST criteria. Survival was calculated with Kaplan-Meier from the time of cancer diagnosis to death with values censored at the date of the last follow-up.ResultsTwenty-six (63.4%) and 8 (19.5%) patients had a complete response after LA and TACE, respectively (p < 0.001). Subsequently we stratified the HCCs in 3 categories according to the nodule size: 40–50 mm, 51–60 mm, and >60 mm. LA resulted superior to TACE especially in nodules ranging between 51 and 60 mm in diameter, with a complete response rate post-LA and post-TACE of 75% and 14.3%, respectively (p = 0.0133). The 36 months cumulative survival rate in patients treated with LA and TACE was 55.4% and 48.8%, respectively. The disease recurrence rates after LA and TACE were 19.5% and 75.0%, respectively.ConclusionsLA is a more effective therapeutic option than TACE in patients with solitary large HCC.
Highlights
Hepatocellular carcinoma (HCC) is the fifth most frequent cancer among males and the ninth in women worldwide
Twenty-six (63.4%) and 8 (19.5%) patients had a complete response after Laser Ablation (LA) and transarterial chemoembolisation (TACE), respectively (p < 0.001)
The 36 months cumulative survival rate in patients treated with LA and TACE was 55.4% and 48.8%, respectively
Summary
Hepatocellular carcinoma (HCC) is the fifth most frequent cancer among males and the ninth in women worldwide. The standard treatment for these patients is transarterial chemoembolization (TACE) despite its unsatisfactory efficacy (complete response only in 25% of subjects [4]), with the occurrence of serious side effects in >10% of cases [5], and with an estimated 1-year recurrence rate of 59% [6]. In a preliminary case-series study, LA with the multifiber technique achieved a complete response in 71% of nodules > 40 mm with mild side effects [11] The aim of this case-control study was to evaluate the efficacy of LA in comparison to TACE in patients with unresectable solitary large HCC (≥ 40 mm). Our study was focused on this specific patients subgroup (solitary large HCC ≥ 40 mm) because traditional thermal ablation techniques (RFA and MWA) are considered less effective than TACE in obtaining a complete response [8,9,10].
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