Transarterial chemoembolization combined with radiofrequency ablation in the treatment of hepatocellular carcinomas larger than 5 cm

Abstract

Aim: This meta-analysis was designed to compare the effectiveness of the combination of transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) vs. that of TACE alone in hepatocellular carcinoma (HCC) tumors larger than 5 cm.

Methods: PUBMED, CNKI, and CBM were searched for all related randomized controlled trials (RCTs) up until October 22, 2018. Eleven studies were identified that compared TACE with RFA vs. TACE alone for HCC treatment. Tumor response rate, the proportion of patients with either complete or partial shrinkage of tumors, and survival rate were the major evaluation indices.

Results: Meta-analysis data revealed that TACE with RFA showed significantly better tumor response rate (risk ratio (RR) = 1.452, 95% confidence interval (CI): 1.308-1.610, P < 0.001) and 1-year overall survival rate (RR = 1.412, 95% CI: 1.249-1.596, P < 0.001) than that of TACE alone treatment.

Conclusion: The data of our study indicates that TACE combined with RFA in the treatment of HCC larger than 5 cm is an effective comprehensive interventional therapy.

Keywords

Transarterial chemoembolization / radiofrequency ablation / hepatocellular carcinoma / meta-analysis

References

[1] Ferenci P,Labrecque D,Sherman M.Hepatocellular carcinoma (HCC): a global perspective..J Clin Gastroenterol2010;44:239-45

[2] Ferlay J,Bray F,Mathers C.Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008..Int J Cancer2010;127:2893-917

[3] Yuen MF,Wong BC,Ooi GC.Transarterial chemoembolization for inoperable, early stage hepatocellular carcinoma in patients with Child-Pugh grade A and B: results of a comparative study in 96 Chinese patients..Am J Gastroenterol2003;98:1181-5

[4] Llovet JM.Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival..Hepatology2003;37:429-42

[5] Marelli L,Buscombe JR,Stigliano R.Transarterial injection of (131)I-lipiodol, compared with chemoembolization, in the treatment of unresectable hepatocellular cancer..J Nucl Med2009;50:871-7

[6] Kim KM,Park IS,Yoon HK.Reappraisal of repeated transarterial chemoembolization in the treatment of hepatocellular carcinoma with portal vein invasion..J Gastroenterol Hepatol2009;24:806-14

[7] Peng ZW,Liang HH,Guo RP.Recurrent hepatocellular carcinoma treated with sequential transcatheter arterial chemoembolization and RF ablation versus RF ablation alone: a prospective randomized trial..Radiology2012;262:689-700

[8] Zhao M,Li W,Zhang FJ.Comparison of safety and efficacy for transcatheter arterial chemoembolization alone and plus radiofrequency ablation in the treatment of single branch portal vein tumor thrombus of hepatocellular carcinoma and their prognosis factors..Zhonghua Yi Xue Za Zhi2011;91:1167-72

[9] Kim JW,Won HJ,Yoon HK.Hepatocellular carcinomas 2-3 cm in diameter: transarterialchemoembolization plus radiofrequency ablation vs. radiofrequency ablation alone..Eur J Radiol2012;81:189-93

[10] Shibata T,Hirokawa Y,Shimada K.Small hepatocellular carcinoma: is radiofrequency ablation combined with transcatheter arterial chemoembolization more effective than radiofrequency ablation alone for treatment?.Radiology2009;252:905-13

[11] Dong YS,Yang XG.Clinical efficacy of transcatheter arterial chemoembolization combined with radiofrequency ablation for large hepatocellular carcinoma..Chinese Journal of General Surgery2013;16:486-88

[12] Du XQ.Analysis of the efficacy of transcatheter arterial chemoembolization combined with radiofrequency ablation in the treatment of primary large liver cancer..Clinical Medical Research and Practice2017;2:15-16

[13] Ge MG.TACE and RFA sequential treatment of 88 cases of advanced liver cancer..Chinese Medical Innovation2009;6:29

[14] Kuang YL,Yang ZL.Analysis of short-term efficacy of transcatheter arterial chemoembolization combined with radiofrequency ablation for advanced primary liver cancer..Journal of Hepatobiliary and Pancreatic Surgery2017;29:363-7

[15] Li T,Zhang KQ.Therapeutic effect of transcatheter arterial chemoembolization combined with ultrasound-guided radiofrequency ablation for large hepatocellular carcinoma..Anhui Medicine2013;17:1709-11

[16] Liang MH.Hepatic arterial chemoembolization combined with multipolar radiofrequency ablation for the treatment of large liver cancer..Chinese Journal of Gerontology2011;31:2862-64

[17] Liu M,Wang HL,Huang WK.Analysis of the efficacy and prognosis of transcatheter arterial chemoembolization (TACE) combined with percutaneous radiofrequency ablation (RFA) in the treatment of advanced hepatocellular carcinoma..Journal of Practical Cancer2015;

[18] Shen L,Yan K,Gao W.To investigate the clinical application of percutaneous radiofrequency ablation combined with hepatic arterial chemoembolization in the treatment of large hepatocellular carcinoma..Chinese Journal of Ultrasound Imaging2004;

[19] Song Y,Long HY.Clinical study of hepatic arterial chemoembolization combined with percutaneous radiofrequency ablation for the treatment of large hepatocellular carcinoma..Advances in Modern and General Surgery2008;11:203-7

[20] Zhang XB,Zheng YH.Clinical study of sequential hepatic arterial chemoembolization combined with radiofrequency ablation for large hepatocellular carcinoma..Chinese Journal of Physicians2016;

[21] Yang P,Zhang Y.Clinical application of a combination therapy of lentinan, multi-electrode RFA and TACE in HCC..Adv Ther2008;25:787-94

[22] Higgins JP,Gøtzsche PC,Moher D.The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials..BMJ2011;343:d5928 PMCID:PMC3196245

[23] Peng ZW,Chen MS,Liang HH.Radiofrequency ablation with or without transcatheter arterial chemoembolization in the treatment of hepatocellular carcinoma: a prospective randomized trial..J Clin Oncol2013;31:426-32

[24] Cho YK,Kim MY,Han JK.Systematic review of randomized trials for hepatocellular carcinoma treated with percutaneous ablation therapies..Hepatology2009;49:453-9

[25] Germani G,Gurusamy K,Isgrò G.Clinical outcomes of radiofrequency ablation, percutaneous alcohol and acetic acid injection for hepatocelullar carcinoma: a meta-analysis..J Hepatol2010;52:380-8

[26] Peng ZW,Liang HH,Guo RP.Recurrent hepatocellular carcinoma treated with sequential transcatheter arterial chemoembolization and RF ablation versus RF ablation alone: a prospective randomized trial..Radiology2012;262:689-700