Abstract
BackgroundThe combination treatment regimen of thermal ablation (TA) and transarterial chemoembolization (TACE) has gained a place in treatment of hepatocellular carcinoma (HCC) lesions > 3 cm unsuitable for surgery. Despite a high heterogeneity in the currently used treatment protocols, the pooled results of combined treatments seem to outperform those of TA or TACE alone. TACE preceding TA has been studied extensively, while results of the reverse treatment sequence are lacking. In this retrospective cohort study we compared the two treatment sequences. Patients and methods38 patients (median age: 68.5 yrs (range 40–84), male: 34, liver cirrhosis: 33, early stage HCC: 21, intermediate stage HCC: 17) were included in two tertiary referral centers, of whom 27 were treated with TA and adjuvant TACE (TA + TACE). The other 11 patients received TA with neoadjuvant TACE (TACE + TA). Overall survival (OS), time to progression (TTP) and local tumor progression (LTP) free survival were determined for the entire cohort and compared between the two treatment sequences. ResultsThe median OS of all patients was 52.7 months and the median time to LTP was 11.5 months (censored for liver transplantation). No differences were found with respect to OS between the two treatment sequences. Median time to LTP for TACE + TA was 23.6 months and 8.1 months for TA + TACE (p = 0.19). DiscussionNo statistical differences were found for OS, TTP and time to LTP between patients treated with TA combined with neoadjuvant or adjuvant TACE.
Highlights
Thermal ablation (TA) is an established treatment for hepatocellular carcinoma (HCC) and considered treatment of choice in HCC lesions < 2 cm, as local tumor progression (LTP) rates are comparable to those after surgical resection [1]
In total 38 patients were included with a median age of 68.5 years old, of which 34 were male
In this retrospective cohort study, we evaluated the effect of com bined thermal ablation (TA) and transarterial chemoembolization (TACE) treatment on Overall survival (OS), time to progression (TTP) and time to LTP
Summary
Thermal ablation (TA) is an established treatment for hepatocellular carcinoma (HCC) and considered treatment of choice in HCC lesions < 2 cm, as local tumor progression (LTP) rates are comparable to those after surgical resection [1]. In order to decrease LTP rates after TA treatments of HCC lesions > 3 cm, Lencioni et al published a first pilot study on the combination of TA with adjuvant TACE (TA + TACE) in 2008 [4]. Subsequent studies most commonly used the reversed sequence of neo-adjuvant TACE before TA (TACE + TA) and confirmed the potential benefit of the combined therapy [5,6]. The combination treatment regimen of thermal ablation (TA) and transarterial chemoembolization (TACE) has gained a place in treatment of hepatocellular carcinoma (HCC) lesions > 3 cm unsuitable for surgery. TACE preceding TA has been studied extensively, while results of the reverse treatment sequence are lacking. Discussion: No statistical differences were found for OS, TTP and time to LTP between patients treated with TA combined with neoadjuvant or adjuvant TACE
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