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Long-Term Outcomes with TACE plus RFA for Hepatocellular Cancers
Regional therapies are a key component of treatment of hepatocellular cancers (HCCs) and include transcatheter arterial embolization (TAE) with chemotherapy (TACE) or without and radiofrequency ablation (RFA). Early-stage HCC is treated with hepatic resection and RFA of small lesions.
Investigators report long-term outcomes from an open-label, multicenter, randomized phase 3 trial comparing RFA with or without TACE in patients in China with early-stage HCC amenable to regional therapy without surgery. In the combination therapy arm, TACE was performed first, followed by RFA. Eligible patients had a solitary lesion ≤7 cm in diameter or three or fewer lesions each ≤3 cm in diameter. Of 189 patients randomized, 77% were men, 89% were hepatitis B surface antigen positive, and 68% had a solitary lesion with a mean size of 3.39–3.47 cm.
At a median follow up of 56 months (TACE-RFA arm) and 50 months (RFA arm), overall survival favored TACE-RFA (62.0 vs. 48.0 months; hazard ratio, 0.55; P=0.001). Recurrence-free survival also favored combination treatment over RFA alone (46.0 vs. 25.0 months; HR, 0.66; P=0.007). All subgroups benefited from combination therapy over RFA alone; however, in patients with tumors ≤3 cm, the TACE-RFA and RFA-alone arms had similar overall survival (HR, 1.4; P=0.19) and recurrence-free survival (HR, 1.12; P=0.62).
Comment
RFA is an accepted therapy for early-stage HCC. This trial indicates a potential benefit for the addition of TACE to RFA, particularly in patients with tumors larger than 3 cm or multifocal tumors.
Citation(s)
Author:
Zhang YJ et al.
Title:
Long-term outcomes of transcatheter arterial chemoembolization combined with radiofrequency ablation as an initial treatment for early-stage hepatocellular carcinoma.
Source:
JAMA Netw Open
2021
Sep
27; [e-pub].
(Abstract/FREE Full Text)
Empfohlen von
David H. Ilson, MD, PhD