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Özen Ö, Boyvat F, Zeydanlı T, Kesim Ç, Karakaya E, Haberal M. Transarterial Chemoembolization Combined with Simultaneous Thermal Ablation for Solitary Hepatocellular Carcinomas in Regions with a High Risk of Recurrence. EXP CLIN TRANSPLANT 2023; 21:512-519. [PMID: 37455470 DOI: 10.6002/ect.2023.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
OBJECTIVES We evaluated the safety and efficacy of transarterial chemoembolization combined with percutaneous thermal ablation (radiofrequency or microwave ablation) in the treatment of solitary hepatocellular carcinoma tumors ranging from 2 to 4.5 cm at subdiaphragmatic, subcapsular, or perivascular locations. MATERIALS AND METHODS Fifteen patients (12 men, mean [range] age of 66.6 ± 10.88 [34-75] y) who received transarterial chemoembolization combined with simultaneous percutaneous radiofrequency ablation (n = 5) or microwave ablation (n = 10) for hepatocellular carcinoma in regions with high risk of recurrence (subdiaphragmatic, subcapsular, or perivascular) between 2012 and 2018 were evaluated. We retrospectively investigated tumor diameter and localization, success rate, safety, local efficacy (imaging at month 1 after treatment), local tumor response (3 months posttreatment), local tumor progression, intrahepatic distant recurrence, overall survival and complications. RESULTS Tumor diameter ranged from 20 to 45 mm (mean 31.7 ± 7.37 mm). Hepatocellular carcinoma diameter was 2 to 3 cm in 7 patients and 3.1 to 4.5 cm in 8 patients. The technical success rate was 100%, with no life-threatening complications. At enhanced imaging at 1-month follow-up, the complete necrosis rate was 100%; at 3 months, 100% of patients had a complete response. During a mean follow-up of 26 ± 13.6 months, 7 patients (46.7%) had tumor progression. Three patients (20%) had local tumor response, and 4 patients (26.7 %) experienced distant recurrences in the untreated liver. The mean local tumor progression and mean intrahepatic distance recurrence times were 11 months and 29.5 months, respectively. Overall survival rates were 100% at 1 year, 73% at 3 years, and 47% at 5 years. CONCLUSIONS Transarterial chemoembolization combined with simultaneous percutaneous thermal ablation is safe, feasible, and effective in enhancing the local control rate for solitary hepatocellular carcinoma ranging from 2 to 4.5 cm in regions with high risk of recurrence.
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Affiliation(s)
- Özgür Özen
- From the Ankara Hospital, Department of Radiology, Baskent University, Ankara, Turkey
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Zhang Y, Chen H, Chen S, Duan Y, Cheng L, Gao J, Li W. Comparison of the Efficacy and Safety of Transarterial Chemoembolization Plus Microwave Ablation versus Surgical Resection in Patients with Solitary Large Hepatocellular Carcinoma: A Propensity Score-Matched Analysis. J Hepatocell Carcinoma 2022; 9:1309-1321. [PMID: 36567798 PMCID: PMC9784473 DOI: 10.2147/jhc.s386264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/27/2022] [Indexed: 12/23/2022] Open
Abstract
Background The liver resection for solitary large hepatocellular carcinoma (SLHCC) remains controversial due to the high risk of complications and recurrence after resection. This study aimed to compare the efficacy and safety of transcatheter arterial chemoembolization (TACE) plus microwave ablation (MWA) with resection for SLHCC. Methods We retrospectively analyzed a total of 148 patients who were treated with either TACE-MWA (n = 94) or resection (n = 54) for SLHCC (≥5 cm). A matched cohort composed of 86 patients was included after propensity score matching (PSM). The primary endpoint was overall survival (OS), and the secondary endpoints were progression-free survival (PFS) and safety. Results The TACE-MWA group was older with higher ALT and AST (all P < 0.05). After PSM, the 1-, 3-, and 5-year OS were 100%, 80.3%, and 51.0% in the TACE-MWA group, and 88.3%, 66.7%, and 39.4% in the liver resection group, respectively. The 1-, 3-, and 5-year PFS were 76.7%, 48.8%, and 19.6% in the TACE-MWA group, and 72%, 40.2%, and 22.6% in the liver resection group, respectively. There was no significant difference in OS and PFS between the two groups (all P > 0.05). For SLHCC patients with tumor size ≥7cm, TACE-MWA showed favorable OS than liver resection. The TACE-MWA group exhibited a lower rate of major complications and shorter hospital stay than the resection group. Conclusion TACE-MWA showed comparable efficacy to liver resection in patients with SLHCC, but better safety and shorter hospital stay. TACE-MWA might provide a longer OS than liver resection for SLHCC patients with tumor size ≥7cm.
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Affiliation(s)
- Yongchao Zhang
- Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Hualei Chen
- Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Shanshan Chen
- Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Youjia Duan
- Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Long Cheng
- Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Jie Gao
- Department of Hepatobiliary Surgery, Peking University People’s Hospital, Beijing, People’s Republic of China,Correspondence: Jie Gao, Department of Hepatobiliary Surgery, Peking University People’s Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People’s Republic of China, Email
| | - Wei Li
- Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, People’s Republic of China,Cancer Center, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China,Wei Li, Cancer Center, Beijing Ditan Hospital, Capital Medical University, 8 Jingshun East Street, Chaoyang District, Beijing, 100015, People’s Republic of China, Email
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Combined Trans-Arterial Embolization and Ablation for the Treatment of Large (>3 cm) Liver Metastases: Review of the Literature. J Clin Med 2022; 11:jcm11195576. [PMID: 36233437 PMCID: PMC9571710 DOI: 10.3390/jcm11195576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: The aim of this review was to determine the state of clinical practice in the role of the combined approach of embolization and ablation in patients with secondary liver lesions greater than 3 cm who are not candidates for surgery, and to study its safety and efficacy. (2) Methods: Two reviewers conducted the literature search independently. Eight articles on the combined approach of embolization and ablation in secondary liver lesions were selected. (3) Results: The studies were published between 2009 and 2020. Two studies were prospective in design. The sample size was < 100 patients for all studies. All studies demonstrated the safety of the combined approach based on the low complication rate. Some studies lamented non-uniform systemic chemotherapy regimens and the variability in the sequence of embolization and ablation. (4) Conclusions: This review presents the combined approach of ablation and embolization in liver lesions greater than 3 cm as a safe therapeutic procedure with positive effects on patient survival. Prospective and multicentric studies are needed to further evaluate its efficacy.
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Dan Y, Meng W, Li W, Chen Z, Lyu Y, Yu T. Transarterial Chemoembolization Combined With Radiofrequency Ablation Versus Hepatectomy for Hepatocellular Carcinoma: A Meta-Analysis. Front Surg 2022; 9:948355. [PMID: 35898584 PMCID: PMC9309475 DOI: 10.3389/fsurg.2022.948355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Although many studies reported the effectiveness of transarterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) or surgical resection (SR) in the treatment of hepatocellular carcinoma (HCC), the efficacy of these two strategies remains controversial. Therefore, this meta-analysis aimed to evaluate and compare the efficacy of sequential use of TACE plus RFA (TACE + RFA) and SR alone in treating HCC. Methods Relevant studies with unmatched and propensity score-matched patients were identified by comprehensive search of MEDLINE, PubMed, EMBASE, Web of Science, and Cochrane electronic databases. Meta-analysis was conducted using Review Manager (RevMan) software version 5.4.1. Finally, 12 eligible studies were included in this study, including 11 case–control studies and 1 randomized controlled trial. The primary outcome of interest for this study was to compare the 1-, 3-, and 5-year overall survival (OS) and disease-free survival (DFS), major complications, 5-year OS in different tumor diameters between the two treatment strategies, and hospital stay time. Results HCC patients who received TACE + RFA had a lower incidence of complication rates and shorter hospital stay time than those who received SR alone. Among these studies using propensity score-matched cohorts, SR had better 3- and 5-year OS than TACE + RFA, whereas there were no significant differences between TACE + RFA and SR regarding the 1-, 3-, and 5-year DFS. When the tumor diameter is longer than 3 cm, the 5-year OS rate is better when SR is selected. Conclusion There was no significant difference in the short-term survival outcomes between TACE + RFA and SR in HCC patients. Moreover, SR is superior to TACE + RFA in terms of long-term beneficial effects but may result in a higher risk of major complications and a longer hospital stay time.
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Affiliation(s)
- Yuan Dan
- Department of Hepatobiliary Surgery, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Wenjun Meng
- Department of Gastrointestinal Surgery, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Wenke Li
- Department of Hepatobiliary Surgery, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Zhiliang Chen
- Department of Hepatobiliary Surgery, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Yongshuang Lyu
- Department of Hepatobiliary Surgery, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Tianwu Yu
- Department of Hepatobiliary Surgery, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
- Correspondence: Tianwu Yu
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Tan Y, Wang X, Ma K, Zhang L, Li J, Chen P, Zhang B. Risk factors for the recurrence of early hepatocellular carcinoma treated by percutaneous radiofrequency ablation with a multiple-electrode switching system: a multicenter prospective study. Int J Hyperthermia 2022; 39:190-199. [PMID: 35042449 DOI: 10.1080/02656736.2021.2024279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To investigate the long-term efficacy of radiofrequency ablation (RFA) with a multiple-electrode switching system (MESS) in the treatment of early hepatocellular carcinoma (HCC) and evaluate the patterns and risk factors of intrahepatic recurrence of HCC after RFA. METHODS In total, 139 patients with early HCC who underwent RFA with MESS as primary treatment at multiple centers were prospectively enrolled according to the inclusion criteria. We evaluated the local tumor progression (LTP), intrahepatic distant recurrence (IDR), the incidence of cumulative disease-free survival (DFS), LTP-free survival, IDR-free survival, and overall survival. We also analyzed the associated risk factors. RESULTS A total of 139 patients were included in the study and the median follow-up time was 64 months, ranging from 11 to 72 months. The complete ablation rate was 98.56%. Sixty-nine (49.64%) were found to have intrahepatic recurrence (LTP, n = 15; IDR, n = 55) during follow-up. The 1-year, 3-year and 5-year cumulative DFS, LTP-free survival, and IDR-free survival rates were 74.82, 94.46 and 78.75%; 54.68, 88.03 and 61.79%; and 51.80, 85.67 and 60.17%, respectively. In the multivariable analysis, tumor size > 4 cm was the only important risk factor for LTP. The alkaline phosphatase (ALP) level and the number of tumors were independent risk factors for IDR; α-fetoprotein (AFP) level > 400 µg/L and recurrence interval were risk factors for the overall survival period. CONCLUSIONS The MESS-RFA is an effective method for local control of tumors in early HCC. Early HCC with multiple high-ALP tumors has a higher rate of recurrence, which mainly occurs in an IDR pattern. Early HCC with high AFP levels and a shorter initial recurrence interval resulted in a poorer prognosis. Thus, treatments such as liver transplantation or surgical resection may be a good strategy in those cases. CLINICALTRIALS.GOV ID NCT02046356.
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Affiliation(s)
- Yunhua Tan
- Department of Epidemiology and Biostatistics, First Affiliated Hospital, Army Medical University, Chongqing, PR China
| | - Xin Wang
- Department of Epidemiology and Biostatistics, First Affiliated Hospital, Army Medical University, Chongqing, PR China
| | - Kuansheng Ma
- Institute of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, PR China
| | - Lin Zhang
- Department of Radiation, Southwest Hospital, Army Medical University, Chongqing, PR China
| | - Jing Li
- Department of Hepatobiliary Surgery, Xinqiao Hospital, Army Medical University, Chongqing, PR China
| | - Ping Chen
- Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, Chongqing, PR China
| | - Ben Zhang
- Department of Epidemiology and Biostatistics, First Affiliated Hospital, Army Medical University, Chongqing, PR China
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Patidar Y, Garg L, Mukund A, Sarin SK. Early experience of combination therapy of transarterial chemoembolization and radiofrequency ablation for hepatocellular carcinoma measuring 3-7 cm. Indian J Radiol Imaging 2021; 29:47-52. [PMID: 31000941 PMCID: PMC6467046 DOI: 10.4103/ijri.ijri_352_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background of the Article: Hepatocellular carcinoma (HCC) is one of the most common human malignancies worldwide. Radiofrequency ablation (RFA) is considered curative option in selected patients; efficacy is severely limited by lesion size and lesions bordering a large vessel. On the other hand, transarterial chemoembolization (TACE) is not limited by lesion size and arterial occlusion of the tumor feeding vessels leads to increase the volume of the ablative zone. Combination treatments using both intraarterial liver-directed therapy and percutaneous ablation seek to overcome the disadvantages of the individual treatments alone, theoretically improving response to therapy and survival. Material and Methods: This is a single-center retrospectively study in which patients who received TACE plus RFA for HCC were evaluated for technical success, local tumor progression rates, distant intra and extrahepatic recurrences and survival. Results: The study included 22 patients, 21 patients had a solitary HCC of size 3–7 cm and one patient had three target lesions. Technical success achieved after first session of combination treatment was 100% (24/24). At 1 and 3 months follow-up 100% patients (24 target lesions) had complete response and at 6 months; 21 (87.5%) had complete response, one (4.2%) had local tumor progression and two patients (8.3%) developed progressive disease. No major difference in complication was noted. The event-free survival as shown by Kaplan–Meier graph analysis at 6 and 12 months were 90.7% and 66.4% with mean time to event-free survival was 11.1 months. Conclusion: The combined use of TACE and RFA is a safe and effective option in the treatment of patients with single large or multinodular HCC when surgical resection is not feasible and this approach provides better results than RFA or TACE alone.
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Affiliation(s)
- Yashwant Patidar
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Lalit Garg
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Amar Mukund
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
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Faiella E, Santucci D, Bernetti C, Schena E, Pacella G, Zobel BB, Grasso RF. Combined trans-arterial embolisation and microwave ablation for the treatment of large unresectable hepatic metastases (>3 cm in maximal diameter). Int J Hyperthermia 2021; 37:1395-1403. [PMID: 33342310 DOI: 10.1080/02656736.2020.1849823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To assess the safety and efficacy of a two-step single-session procedure, combining transarterial embolization (TAE) and percutaneous microwave ablation (MWA), in the treatment of > 3 cm unresectable liver metastases. We also compared the final volume obtained by the two techniques (VE-T) and the expected ablation volume of the stand-alone MWA (VT). METHODS From January 2015 to December 2017, 22 consecutive patients, with a total of 24 unresectable hepatic metastases >3 cm in diameter underwent a two-step single-session combined treatment of TAE and MWA. Follow-up computed tomography scans were performed at 1-, 3-, 6-, 12, and 24 months post-procedure. VE-T as final ablation volume induced by the combined treatment (TAE-MWA), VN as initial nodule volume, VT as expected ablation volume of MWA treatment alone were evaluated and compared. RESULTS Tumor dimensions ranged from 32 to 73 mm. Technical success was achieved in all treated tumors with no local tumor recurrence. Final ablation volumes ranged from 50 to 450 cm3 and the short-axis diameter of the ablation zone ranged from 12 to 48 mm. The mean ΔV increment in the final ablation volume with respect to the stand-alone MWA was 196% (ranging from 25 cm3 - 210 cm3) (p < 0.05). The VE-T mean was four times the VN mean, while the VT mean was about twice the VN mean. No recurrence and only one case of post-embolization bleeding were observed. CONCLUSIONS This study demonstrated the safety and efficacy of a combined two-step single-session TAE-MWA treatment of unresectable hepatic metastases > 3 cm in diameter.
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Affiliation(s)
- Eliodoro Faiella
- Department of Radiology, Campus Bio-Medico University, Rome, Italy
| | | | | | - Emiliano Schena
- Center for Integrated Research, University Campus Bio-Medico di Roma, Rome, Italy
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Yuan P, Wang F, Zhu G, Chen B. The clinical efficiency of TACE combined with simultaneous computed tomography-guided radiofrequency ablation for advanced hepatocellular carcinoma. Invest New Drugs 2021; 39:1383-1388. [PMID: 33754235 DOI: 10.1007/s10637-021-01101-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/12/2021] [Indexed: 02/08/2023]
Abstract
Background To investigate the clinical efficiency of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) for advanced hepatocellular carcinoma (HCC). Methods This retrospective study enrolled 177 HCC patients, and they were divided into TACE monotherapy group (n = 129) and TACE + RFA group (n = 48) between January 2015 and October 2017. The objective response rate (ORR), disease control rate (DCR), and the survival outcomes were compared between the TACE monotherapy and the treatment of TACE + RFA after propensity score matching (PSM). Results After PSM matching, the confounding factors had no significant differences between the 48 pairs of patients. The DCR was calculated as 33 (69 %) and 42 (88 %) for the TACE monotherapy group and TACE + RFA group, respectively (P < 0.05). And the ORR was calculated as 23 (48 %) and 35 (73 %), respectively (P < 0.05). Moreover, the PFS rate of the TACE + RFA group was significantly higher than the TACE alone group (P < 0.001). Conclusions The treatment of TACE combined with RFA has better tumor response rate and survival rate than the TACE monotherapy for patients with advanced HCC.
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Affiliation(s)
- Peng Yuan
- Department of Hematology and Oncology (Key Discipline of Jiangsu Medicine), Medical School, Zhongda Hospital, Southeast University, No. 87 Dingjiaqiao, Gulou District, Jiangsu Province, 210009, Nanjing, People's Republic of China
| | - Fei Wang
- Department of Hematology and Oncology (Key Discipline of Jiangsu Medicine), Medical School, Zhongda Hospital, Southeast University, No. 87 Dingjiaqiao, Gulou District, Jiangsu Province, 210009, Nanjing, People's Republic of China
| | - Guangyu Zhu
- Department of Interventional Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, 210009, Jiangsu Province, People's Republic of China
| | - Baoan Chen
- Department of Hematology and Oncology (Key Discipline of Jiangsu Medicine), Medical School, Zhongda Hospital, Southeast University, No. 87 Dingjiaqiao, Gulou District, Jiangsu Province, 210009, Nanjing, People's Republic of China.
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Chen L, Sun T, Kan X, Chen S, Ren Y, Cao Y, Yan L, Liang B, Xiong B, Zheng C. Transarterial chemoembolization combined with iodine-125 seed implantation for patients with hepatocellular carcinoma: a retrospective controlled study. J Int Med Res 2020; 48:300060520944309. [PMID: 33050765 PMCID: PMC7570795 DOI: 10.1177/0300060520944309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objective To determine if iodine-125 seed implantation improved the efficacy of transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) (≤5 cm). Methods We retrospectively reviewed the medical records of 83 consecutive patients with HCC (≤5 cm) who underwent TACE or TACE–iodine-125 from January 2014 to July 2017. The primary endpoint was progression-free survival (PFS). The secondary endpoints were overall survival (OS) and objective response rate (ORR) at 3 months after the first TACE treatment. PFS and OS were calculated using the Kaplan–Meier method and compared using log-rank tests. Independent risk factors for PFS and OS were analyzed using a Cox proportional hazards model. Results Thirty-five patients received TACE–iodine-125 and 48 received TACE alone. The median OS and PFS were both significantly longer in the TACE–iodine-125 compared with the TACE-alone group (42 vs 23 months and 16 vs 8 months, respectively). The ORR was significantly higher in the TACE–iodine-125 compared with the TACE-alone group. There was no significant difference in adverse events, apart from decreased white cell count, between the two groups. Conclusion TACE–iodine-125 might be an effective and safe alternative treatment for patients with HCC (≤5 cm).
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Affiliation(s)
- Lei Chen
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Tao Sun
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xuefeng Kan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Shi Chen
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yanqiao Ren
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yanyan Cao
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Liangliang Yan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Bin Liang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Bin Xiong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
- Chuansheng Zheng, 1277 Jiefang Avenue, Jianghan District, Wuhan 430022, China.
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Chen L, Kan X, Sun T, Ren Y, Cao Y, Yan L, Liang B, Xiong B, Zheng C. Transarterial chemoembolization combined with iodine 125 seeds versus transarterial chemoembolization combined with radiofrequency ablation in the treatment of early- and intermediate-stage hepatocellular carcinoma. BMC Gastroenterol 2020; 20:205. [PMID: 32600349 PMCID: PMC7324959 DOI: 10.1186/s12876-020-01355-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 06/22/2020] [Indexed: 12/16/2022] Open
Abstract
Background Transarterial chemoembolization (TACE), radiofrequency ablation (RFA), and iodine 125 seeds implantation are optional treatments for hepatocellular carcinoma (HCC). The aim of this study is to compare the efficacy of the combined treatment of TACE with iodine 125 seeds implantation (TACE-iodine 125) with TACE with RFA (TACE-RFA) in patients with early- and intermediate-stage HCC. Methods The study included 112 patients who were diagnosed with early- and intermediate-stage HCC from January 1, 2014, to May 31, 2018. Among them, 38 patients were treated with TACE-Iodine 125, and 74 with TACE-RFA. The efficacy of the two treatment groups was retrospectively analyzed. To reduced the selective bias, a propensity score matching (PSM) analysis and inverse probability of treatment weighting (IPTW) method were used to compare the outcomes between the two groups. Results In the absence of PSM and IPTW, the median overall survival (OS) and progression-free survival (PFS) of the TACE-RFA group were slightly longer than those of the TACE-Iodine 125 group (OS: 41 months vs. 36 months; PFS: 18 months vs. 15 months). However, there were no statistically significant differences in the median OS, PFS, and objective response rate (ORR) between the two groups (P > 0.05). After adjusting the age, gender, Child-Pugh class, Barcelona Clinic Liver Cancer (BCLC) stage, and Alpha-fetoprotein (AFP), TACE-Iodine 125 treatment was not associated with a significant increasing the risks of death (HR: 0.763; 95%CI: 0.403,1.345, P = 0.320) and recurrence (HR: 1.020; 95%CI: 0.645,1.611, P = 0.934). After PSM, 35 matched pairs of patients were obtained, and there were no statistically significant differences in the median OS and PFS between the two groups. After IPTW, similar results presented. Conclusions The combination of TACE with iodine 125 seeds implantation may represent an effective treatment for patients with early- and intermediate-stage HCC.
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Affiliation(s)
- Lei Chen
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Xuefeng Kan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Tao Sun
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Yanqiao Ren
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Yanyan Cao
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Liangliang Yan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Bin Liang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Bin Xiong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China. .,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
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Transcatheter arterial chemoembolization alone or combined with ablation for recurrent intermediate-stage hepatocellular carcinoma: a propensity score matching study. J Cancer Res Clin Oncol 2020; 146:2669-2680. [PMID: 32449005 DOI: 10.1007/s00432-020-03254-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/12/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The recurrence after curative hepatectomy is common. Limited data have investigated the effect of transcatheter arterial chemoembolization (TACE) combined with ablation in treating recurrent intermediate-stage hepatocellular carcinoma (HCC) after hepatectomy. We aim to compare the efficacy of TACE combined with ablation versus TACE alone in treating recurrent intermediate-stage HCC after hepatectomy. METHODS A total of 183 patients with recurrent intermediate-stage HCC after hepatectomy were enrolled at Sun Yat-sen University Cancer Centre, including 111 patients who underwent TACE alone and 72 patients who underwent TACE combined with ablation (TACE-Ablation). Overall survival (OS) and progression-free survival (PFS) were compared by the log-rank test. Propensity score matching (PSM) was used to reduce the confounding bias. RESULTS Before PSM, the 5-year OS rates were 43.3% vs. 27.9% (P = 0.001), and the 5-year PFS rates were 21.7% vs. 13.0% (P < 0.001) for TACE-Ablation and TACE-alone groups, respectively. After PSM, TACE-Ablation still resulted in better 5-year OS (41.6% vs. 30.2%, P = 0.028) and 5-year PFS rate (21.3% vs. 15.8%, P = 0.024) than that of TACE alone. Patients in TACE-Ablation group exhibited similar major complication rates to TACE-alone group but higher minor complication rates both before and after PSM. Cox regression analysis identified TACE-alone modality as an independently unfavourable predictor for OS and PFS (both P < 0.05). CONCLUSION TACE combined with ablation is safe and superior to TACE alone in tumour control and prolonging overall survival in recurrent intermediate-stage HCC after hepatectomy.
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12
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Gui CH, Baey S, D'cruz RT, Shelat VG. Trans-arterial chemoembolization + radiofrequency ablation versus surgical resection in hepatocellular carcinoma - A meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020; 46:763-771. [PMID: 31937433 DOI: 10.1016/j.ejso.2020.01.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 12/09/2019] [Accepted: 01/02/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hepatocellular Carcinoma (HCC) remains the third most common cause of cancer death worldwide, with countries in Asia being affected the most. The mainstay of curative therapy for early HCC is radiofrequency ablation (RFA) or surgery; either surgical resection (SR) or liver transplantation. Latest evidence however suggests that combination of TACE+ RFA may provide outcomes comparable to SR. AIM To compare oncologic outcomes and safety profile of TACE + RFA to SR alone in HCC. MATERIALS AND METHODS A systematic review was conducted through Pubmed, EMBASE and Cochrane Library for literature published before April 2019. Outcomes measured were disease-free survival(DFS), overall survival(OS) and major complications. DFS was further divided into local tumour progression(LTP), intrahepatic distant recurrence(IDR) and distant metastasis(DM). RESULTS Eight retrospective studies and one randomized controlled trial, involving 1892 patients met eligibility criteria and were included. Unadjusted pooled analysis demonstrated no significant difference in 1-year, 3-year and 5-year OS and 1-year DFS between TACE+RFA and SR. SR had superior 3-year DFS (OR 0.78, 95% CI 0.62-0.98, p = 0.03) and 5-year DFS (OR 0.74, 95% CI 0.58-0.95, p = 0.02) compared to TACE+RFA. When analysing only the propensity matched data, the difference in 3-year DFS and 5-year DFS was not significant. TACE+RFA had a higher LTP rate (OR 2.48, 95% CI 1.05-5.86, p = 0.04) compared to SR but IDR and DM rates were not significant. DISCUSSION AND CONCLUSION TACE+RFA offer comparable oncologic outcomes in patients with HCC as compared with SR and with added benefit of lower morbidity.
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Song Q, Ren W, Fan L, Zhao M, Mao L, Jiang S, Zhao C, Cui Y. Long-Term Outcomes of Transarterial Chemoembolization Combined with Radiofrequency Ablation Versus Transarterial Chemoembolization Alone for Recurrent Hepatocellular Carcinoma After Surgical Resection. Dig Dis Sci 2020; 65:1266-1275. [PMID: 31312995 DOI: 10.1007/s10620-019-05733-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/10/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND There is lack of data for identifying optimal local therapy for the management of recurrent hepatocellular carcinoma (HCC) after hepatic resection. AIMS A retrospective study was performed to compare the effectiveness of transarterial chemoembolization (TACE) plus radiofrequency ablation (RFA) with that of TACE alone for recurrent HCC. METHODS From 2007 to 2013, patients with recurrent HCC ≤ 5 cm were treated with either TACE plus RFA (n = 96) or TACE (n = 63). Inverse probability of treatment weighting was used to make allowances for imbalances in treatment assignment. The disease-free survival (DFS) and overall survival (OS) were retrospectively analyzed. RESULTS The TACE group had lower pretreatment Child-Pugh class (P = 0.025) and shorter pretreatment interval of recurrence (P = 0.028). The 1-, 3-, and 5-year DFS rates for the TACE-RFA group were 55.1%, 22.5%, and 9.7%, respectively, and 41.1%, 9.9%, and 4.9%, respectively, for the TACE group. The OS rates at 1, 3, and 5 years were 82.3%, 42.7%, and 16.5%, respectively, in the TACE-RFA group, and 75.9%, 30.7%, and 11.3%, respectively, in the TACE group. Cirrhosis was significantly associated with disease progression (hazard ratio [HR] 1.53; 95% CI 1.09-2.14; P = 0.014). CONCLUSIONS In patients with recurrent HCC ≤ 5 cm, TACE-RFA shows better DFS than TACE alone as a first-line local therapy.
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Affiliation(s)
- Qingfeng Song
- Department of Medical Research, Affiliated Tumor Hospital of Guangxi Medical University, No. 22 Shuangyong Rd, Nanning, China
| | - Weizheng Ren
- Department of Hepatobiliary Surgery, The First Medical Center, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
| | - Liwei Fan
- Department of Interventional Radiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Meiqi Zhao
- Department of Medical Research, Affiliated Tumor Hospital of Guangxi Medical University, No. 22 Shuangyong Rd, Nanning, China
| | - Lisha Mao
- Department of Medical Research, Affiliated Tumor Hospital of Guangxi Medical University, No. 22 Shuangyong Rd, Nanning, China
| | - Shichai Jiang
- Department of Medical Research, Affiliated Tumor Hospital of Guangxi Medical University, No. 22 Shuangyong Rd, Nanning, China
| | - Chang Zhao
- Department of Interventional Radiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Ying Cui
- Department of Medical Research, Affiliated Tumor Hospital of Guangxi Medical University, No. 22 Shuangyong Rd, Nanning, China.
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Du S, Yang JZ, Chen J, Zhou WG, Sun YY. Comparisons of recurrence-free survival and overall survival between microwave versus radiofrequency ablation treatment for hepatocellular carcinoma: A multiple centers retrospective cohort study with propensity score matching. PLoS One 2020; 15:e0227242. [PMID: 31918433 PMCID: PMC6952252 DOI: 10.1371/journal.pone.0227242] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 12/16/2019] [Indexed: 12/12/2022] Open
Abstract
Both microwave (MW) ablation and radiofrequency (RF) ablation are widely used for hepatocellular carcinoma (HCC) treatments in clinic. However, it is still unclear if ablative methods could influence the recurrence-free survival (RFS) and overall survival (OS) of HCC patients. Therefore, we carried out this multi-center retrospective cohort study to investigate the differences of recurrence-free survival (RFS) and overall survival (OS) between MW ablation and RF ablation by survival analysis. From January 2014 to December 2016, patients who received thermal ablation surgery for HCC treatment were screened. Finally, 452 patients met the eligibility criteria and finished the follow-up. Univariable and multivariable regression analyses were used to identify independent predictive factors of the RFS and OS. Also, propensity score matching (PSM) was used to balance the bias between two groups. Finally, we found that before the PSM, the univariable and multivariable regression analyses revealed that there were no significant differences on the RFS between two groups. Same results were obtained for the OS. After PSM, 115 pairs of patients were created, and both the univariable and multivariable regression analyses suggested that there were still no significant differences on the RFS between two groups. Same results were obtained for the OS. In conclusion, our present study showed that there were no significant differences between MW ablation and RF ablation for HCC patients on the RFS or OS.
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Affiliation(s)
- Shibin Du
- Department of Anesthesiology, Shenzhen University Clinical Medical Academy, Shenzhen University, Shenzhen University General Hospital, Shenzhen, China
| | - Jian-Zhi Yang
- Department of Anesthesiology, Hanzhong Central Hospital, Hanzhong, Shanxi, China
| | - Jing Chen
- Department of Endocrinology, The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan, China
| | - Wei-gang Zhou
- Department of Anesthesiology, Hanzhong Central Hospital, Hanzhong, Shanxi, China
- * E-mail: (WZ); (YS)
| | - Yan-Yan Sun
- Department of Anesthesiology, Shenzhen University Clinical Medical Academy, Shenzhen University, Shenzhen University General Hospital, Shenzhen, China
- * E-mail: (WZ); (YS)
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15
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Liu D, Liu M, Su L, Wang Y, Zhang X, Long H, Kuang M, Xie X, Lin M. Transarterial Chemoembolization Followed by Radiofrequency Ablation for Hepatocellular Carcinoma: Impact of the Time Interval between the Two Treatments on Outcome. J Vasc Interv Radiol 2019; 30:1879-1886. [PMID: 31669087 DOI: 10.1016/j.jvir.2019.07.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/18/2019] [Accepted: 07/24/2019] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To compare the efficacy of radiofrequency (RF) ablation after transarterial chemoembolization within or beyond 30 days for medium-large or multiple recurrent hepatocellular carcinomas (HCCs). MATERIALS AND METHODS In this single-center retrospective study conducted from 2007 through 2015, 135 patients with a single recurrent HCC (>3 cm) or multiple (2-5 tumors) recurrent HCCs underwent transarterial chemoembolization plus RF ablation. A total of 62 patients underwent RF ablation after transarterial chemoembolization within 30 days (sequential group) and 73 patients underwent RF ablation after transarterial chemoembolization beyond 30 days (delayed group). Outcomes of interests included overall survival (OS), progression-free survival (PFS), and complete response (CR) rate. RESULTS The median OS and PFS were 49.8 and 38.0 months for sequential group, and 31.0 and 11.6 months for the delayed group. The sequential group experienced significantly better OS (hazard ratio [HR]: 0.517; P = .002) and PFS (HR, 0.621; P = .021). Among patients with multiple tumors or a single tumor >5 cm, the sequential group still had significantly longer OS (P = .022; P = .018, respectively) and PFS (P = 0.042; P = .036, respectively) than the delayed group, although no significant differences were observed among patients with solitary 3- to 5-cm tumors (P = .138; P = .803, respectively). The sequential group had a significantly better CR rate than the delayed group (85.4% vs. 68.5%, respectively; P = .035). Significant predictors of OS and PFS included maximum tumor size, number of tumors, and time interval between transarterial chemoembolization and RF ablation. CONCLUSIONS Transarterial chemoembolization plus sequential RF ablation within 30 days was more effective for recurrent HCCs than transarterial chemoembolization plus delayed RF ablation. The time interval within 30 days is required for treating large or multiple HCCs but may not be necessary for solitary medium-sized HCC.
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Affiliation(s)
- Dan Liu
- Department of Medical Ultrasonics, Division of Interventional Ultrasound, Institute for the Study of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Ming Liu
- Department of Medical Ultrasonics, Division of Interventional Ultrasound, Institute for the Study of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Liya Su
- Department of Medical Ultrasonics, Division of Interventional Ultrasound, Institute for the Study of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yu Wang
- Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xiaoer Zhang
- Department of Medical Ultrasonics, Division of Interventional Ultrasound, Institute for the Study of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Haiyi Long
- Department of Medical Ultrasonics, Division of Interventional Ultrasound, Institute for the Study of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Ming Kuang
- Department of Medical Ultrasonics, Division of Interventional Ultrasound, Institute for the Study of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China; Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, Division of Interventional Ultrasound, Institute for the Study of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Manxia Lin
- Department of Medical Ultrasonics, Division of Interventional Ultrasound, Institute for the Study of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.
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16
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Kan X, Wang Y, Han P, Yao Q, Qian K, Xiong B, Zheng C. Combined ultrasound/computed tomography guidance in percutaneous radiofrequency ablation after transarterial chemoembolization for hepatocellular carcinoma in the hepatic dome. Cancer Manag Res 2019; 11:7751-7757. [PMID: 31616188 PMCID: PMC6699493 DOI: 10.2147/cmar.s212127] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 07/28/2019] [Indexed: 12/18/2022] Open
Abstract
Purpose To assess the value of the combined ultrasound (US)/computed tomography (CT) guidance (US guidance was firstly used for puncture with the electrode needle to the site close to the tumor, and subsequently, CT guidance was used for precise positioning of the electrode tips) in percutaneous radiofrequency ablation (RFA) after transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) in the hepatic dome. Methods From January 1, 2013 to June 30, 2017, medical records of 65 patients with HCCs in the hepatic dome who received TACE treatment before RFA procedure were retrospectively analyzed. Among them, 34 patients with 35 liver tumors underwent percutaneous RFA under combined US/CT guidance, and 31 patients with 35 liver tumors received percutaneous RFA under CT guidance alone. The efficacy of combined US/CT-guided RFA was analyzed, and the procedure time and safety between the two groups were compared. Results In the combined US/CT-guided RFA group, the 1-, 3-, and 5-year local recurrence rates were 3%, 6%, 9%, respectively, and the 1-, 3-, and 5-year overall survival rates were 100%, 97%, 94%, respectively. The mean procedure time in the CT-guided RFA group was significantly longer than that of the combined US/CT-guided RFA group (P<0.001). Although the overall complication rates between the two groups were not statistically significant, there were no occurrences of RFA-related complications in the combined US/CT-guided RFA group. The incidence of postoperative adverse reaction of right upper quadrant pain in the CT-guided RFA group was greater than that of the combined US/CT-guided RFA group (P=0.01). Conclusion Percutaneous RFA under the combined US/CT guidance was helpful for HCC in the hepatic dome.
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Affiliation(s)
- Xuefeng Kan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yong Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China.,Department of Vascular and Interventional Radiology, The Second Affiliated Hospital of Hainan Medical University, Haikou 570311, China
| | - Ping Han
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Qi Yao
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Kun Qian
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Bin Xiong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
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17
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Liu Y, Xue D, Tan S, Zhang Q, Yang X, Li Y, Zhu B, Niu S, Jiang L, Wang X. Comparison of macrovascular invasion-free survival in early-intermediate hepatocellular carcinoma after different interventions: A propensity score-based analysis. J Cancer 2019; 10:4063-4071. [PMID: 31417651 PMCID: PMC6692624 DOI: 10.7150/jca.29850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 05/17/2019] [Indexed: 12/13/2022] Open
Abstract
Objectives: The purpose of this study was to compare macrovascular invasion (MVI)-free survival (MFS) at the three-year follow-up in patients with hepatocellular carcinoma (HCC) who underwent hepatic resection (HR), transcatheter arterial chemoembolization (TACE), or TACE combined with radiofrequency ablation (TACE-RFA). Materials and Methods: We retrospectively analyzed the medical records of 828 patients who were diagnosed with Barcelona Clinic Liver Cancer (BCLC) stage A or stage B HCC. Of these patients, 116 underwent HR, 395 underwent TACE-RFA, 239 underwent TACE, and 78 patients received conservative treatment (control group). A validation cohort of 158 patients was included. The MFS and overall survival (OS) before and after propensity score (PS) matching were evaluated using Kaplan-Meier analysis. Results: The baseline characteristics between the control and TACE groups were comparable. MFS was higher in the TACE group than in the control group at the three-year follow-up (p = 0.0091), and OS was similar in the two groups (p = 0.0549). PS matching was used to generate 68 pairs of patients in the control versus HR group and 74 pairs of patients in the control versus TACE-RFA group (1-to-1 matched). MFS was significantly higher in the HR or TACE-RFA groups than in the control group (p < 0.0001 (HR versus control) and p = 0.0001 (TACE-RFA versus control), respectively). Furthermore, for patients in the HR versus TACE-RFA versus TACE groups that were generated by PS matching, the Kaplan-Meier analysis showed that MFS and OS were higher with HR or TACE-RFA than with TACE at three years. In the study, similar results were obtained in the validation cohort. Conclusions: MFS and OS were higher with HR or TACE-RFA than with TACE for HCC patients without MVI.
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Affiliation(s)
- Yao Liu
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University. Beijing 100015, China
| | - Dongying Xue
- Department of Infections Disease, Putuo Hospital, Shanghai University of Traditional Chinese Medicine. Shanghai 200062, China
| | - Shanzhong Tan
- Department of Integrated TCM and Western Medicine, the Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing 210003, China
| | - Qun Zhang
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University. Beijing 100015, China
| | - Xue Yang
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University. Beijing 100015, China
| | - Yuxin Li
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University. Beijing 100015, China
| | - Bingbing Zhu
- Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine. Beijing 100700, China
| | - Shuaishuai Niu
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University. Beijing 100015, China
| | - Li Jiang
- Department of Surgery, Beijing Ditan Hospital, Capital Medical University. Beijing 100015, China
| | - Xianbo Wang
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University. Beijing 100015, China
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Combined Therapy with Transarterial Chemoembolization and Radiofrequency Ablation for Hepatocellular Carcinoma: Does the Degree of Ethiodized Oil Accumulation within the Tumor Affect the Therapeutic Efficacy? J Vasc Interv Radiol 2019; 30:370-379.e4. [PMID: 30819479 DOI: 10.1016/j.jvir.2018.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 09/06/2018] [Accepted: 09/10/2018] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To evaluate the effects of the degree of ethiodized oil accumulation achieved by transarterial chemoembolization followed by radiofrequency (RF) ablation on the treatment efficacy for a single intermediate-sized hepatocellular carcinoma (HCC). MATERIALS AND METHODS A total of 153 consecutive patients who underwent chemoembolization and RF ablation for a single intermediate-sized HCC (2-5 cm) were included. On the basis of the degree of ethiodized oil accumulation in HCC on cone-beam CT images, patients who underwent chemoembolization and RF ablation were classified into 2 groups: compact accumulation (≥ 75%) and noncompact accumulation (< 75%). The rates of cumulative local tumor progression (LTP), disease-free survival (DFS), and overall survival (OS) were compared between groups. RESULTS Of the 153 patients, 89 were classified into the compact ethiodized oil accumulation group and 64 in the noncompact ethiodized oil accumulation group. There were no significant differences in patient demographic or HCC characteristics between groups except for the incidence of liver cirrhosis (P = .038) and the tumor margin morphology (P = .008). The cumulative LTP rate was significantly lower in the compact accumulation group than in the noncompact accumulation group (P = .013). There were no significant differences in the incidences of complications, DFS rates (P = .055), or OS rates (P = .184). CONCLUSIONS The degree of ethiodized oil accumulation does not play a role in decreasing the OS or DFS rate after chemoembolization and RF ablation for intermediate-sized HCC; however, it may contribute to reducing the rate of LTP.
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Lee HJ, Kim JW, Hur YH, Cho SB, Lee BC, Lee BK, Hwang EC, Cho YS, Seon HJ. Conventional Chemoembolization Plus Radiofrequency Ablation versus Surgical Resection for Single, Medium-Sized Hepatocellular Carcinoma: Propensity-Score Matching Analysis. J Vasc Interv Radiol 2019; 30:284-292.e1. [DOI: 10.1016/j.jvir.2018.09.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 09/08/2018] [Accepted: 09/24/2018] [Indexed: 12/26/2022] Open
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20
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Kim AR, Park E, Kwon SY, Park SJ, Kim YJ, Yoo BC, Choe WH, Kim JH, Hwang JH, Park SW, Kim YJ, Park HS, Yu MH, Jeon HJ. Efficacy and Safety of Combined Radiofrequency Ablation with Transarterial Chemoembolization in Patients with Barcelona Clinic Liver Cancer Stage A Hepatocellular Carcinoma Ineligible for Curative Treatment. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2019; 73:167-176. [DOI: 10.4166/kjg.2019.73.3.167] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/21/2018] [Accepted: 01/17/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Ah Ran Kim
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Eugene Park
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - So Young Kwon
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Seong Jun Park
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Young Jung Kim
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Byung Chul Yoo
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Won Hyeok Choe
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jeong Han Kim
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jin Ho Hwang
- Department of Radiology, Konkuk University School of Medicine, Seoul, Korea
| | - Sang Woo Park
- Department of Radiology, Konkuk University School of Medicine, Seoul, Korea
| | - Young Jun Kim
- Department of Radiology, Konkuk University School of Medicine, Seoul, Korea
| | - Hee Sun Park
- Department of Radiology, Konkuk University School of Medicine, Seoul, Korea
| | - Mi hye Yu
- Department of Radiology, Konkuk University School of Medicine, Seoul, Korea
| | - Hae jeong Jeon
- Department of Radiology, Konkuk University School of Medicine, Seoul, Korea
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Wang CY, Li S. Clinical characteristics and prognosis of 2887 patients with hepatocellular carcinoma: A single center 14 years experience from China. Medicine (Baltimore) 2019; 98:e14070. [PMID: 30681563 PMCID: PMC6358325 DOI: 10.1097/md.0000000000014070] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
This study was aimed to estimate the survival rate characteristics of 2887 hepatocellular carcinoma (HCC) patients in the single-center and identify useful prognostic factors to help in the clinical management of patients with HCC.Two thousand eight hundred eighty-seven patients diagnosed with HCC at the Fourth Hospital of Hebei Medical University, China, between January 2002 and December 2015 were involved.The causes and baseline characteristics were summarized. Median survival time was 9.0 (20.0) months. Overall, HCC patients showed 1-, 2-, 3-, and 5-year survival rates equal to 49.3%, 35.3%, 26.6%, and19.5% respectively. The median survival time of HCC patients first hospitalized in 2009 to 2015 was higher than those in 2002 to 2008. The results showed that the Barcelona clinic liver cancer (BCLC) stage and Tumor size were independent prognostic factors to HCC patients.The survival rate of HCC patients has increased in recent years, but the overall survival rate and the prognosis were poor.
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22
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Tian G, Yang S, Yuan J, Threapleton D, Zhao Q, Chen F, Cao H, Jiang T, Li L. Comparative efficacy of treatment strategies for hepatocellular carcinoma: systematic review and network meta-analysis. BMJ Open 2018; 8:e021269. [PMID: 30341113 PMCID: PMC6196801 DOI: 10.1136/bmjopen-2017-021269] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 06/28/2018] [Accepted: 08/22/2018] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Hepatocellular carcinoma (HCC) is the third leading cause of cancer death worldwide. We conducted network meta-regression within a Bayesian framework to compare and rank different treatment strategies for HCC through direct and indirect evidence from international studies. METHODS AND ANALYSES We pooled the OR for 1-year, 3-year and 5-year overall survival, based on lesions of size ˂ 3 cm, 3-5 cm and ≤5 cm, using five therapeutic options including resection (RES), radiofrequency ablation (RFA), microwave ablation (MWA), transcatheter arterial chemoembolisation (TACE) plus RFA (TR) and percutaneous ethanol injection (PEI). RESULTS We identified 74 studies, including 26 944 patients. After adjustment for study design, and in the full sample of studies, the treatments were ranked in order of greatest to least benefit as follows for 5 year survival: (1) RES, (2) TR, (3) RFA, (4) MWA and (5) PEI. The ranks were similar for 1- and 3-year survival, with RES and TR being the highest ranking treatments. In both smaller (<3 cm) and larger tumours (3-5 cm), RES and TR were also the two highest ranking treatments. There was little evidence of inconsistency between direct and indirect evidence. CONCLUSION The comparison of different treatment strategies for HCC indicated that RES is associated with longer survival. However, many of the between-treatment comparisons were not statistically significant and, for now, selection of strategies for treatment will depend on patient and disease characteristics. Additionally, much of the evidence was provided by non-randomised studies and knowledge gaps still exist. More head-to-head comparisons between both RES and TR, or other approaches, will be necessary to confirm these findings.
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Affiliation(s)
- Guo Tian
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shigui Yang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jinqiu Yuan
- Division of Epidemiology, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
- Shenzhen Municipal Key Laboratory for Health Risk Analysis, Shenzhen Research, Institute of The Chinese University of Hong Kong, Shenzhen, China
| | - Diane Threapleton
- Division of Epidemiology, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Qiyu Zhao
- Department of Ultrasonography, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fen Chen
- Department of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hongcui Cao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tian’an Jiang
- Department of Ultrasonography, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lanjuan Li
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Alexander ES, Mick R, Nadolski GJ, Mondschein JI, Stavropoulos SW, Soulen MC. Combined chemoembolization and thermal ablation for the treatment of metastases to the liver. Abdom Radiol (NY) 2018; 43:2859-2867. [PMID: 29500644 DOI: 10.1007/s00261-018-1536-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE The purpose of the study was to evaluate safety, time to recurrence, and overall survival (OS) in patients with liver metastases (LM), treated with transarterial chemoembolization (TACE) followed by ablation. MATERIALS AND METHODS This retrospective study included all patients with LM treated with combined TACE and ablation from August 1998 to September 2015. Forty-two patients (12 women, 30 men; age 62.9 ± 11.9 years) were treated for 44 LMs. Tumor characteristics, imaging response to treatment, recurrence, and OS data were reviewed. Statistical analysis included Kaplan-Meier estimation, Cox regression and Fisher's exact, Wilcoxon rank sum, or log rank tests. RESULTS Median follow-up was 10.3 months. Eighteen patients had 1 hepatic lesion, 16 had 2-5, and 8 had > 5. Median index lesion size was 4.7 cm (range 1.5-8 .0 cm). Tumor response (mRECIST) was available for 41/44 treated lesions, with CR in 32 (78.0%), PR in 8 (19.5%), and PD in 1 (2.4%). Long-term imaging follow-up was available for 38 patients. Freedom from local recurrence was 61% at 1 year and 50% at 2 years. OS was 55% at 1 year and 30% at 2 years (median OS, 14.5 months). Tumor size and histology were not predictors of time to progression or OS. Complications occurred in 19 patients (45%). Major complications occurred in 19% of patients and included hospitalization for fever (n = 2), hepatic abscess (n = 3) and fall requiring transfusion, portal vein thrombus causing lobar infarct, biliary fistula, and retroperitoneal hematoma (n = 1 each). CONCLUSIONS Combined TACE and ablation is effective for local tumor control of liver metastases up to 8 cm when part of a multidisciplinary treatment strategy. Major complications occurred in 19% of patients.
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Affiliation(s)
- Erica S Alexander
- Department of Diagnostic Imaging, Hospital of the University of Pennsylvania, 3400 Spruce St, 1 Founders - MRI Education Center, Philadelphia, PA, 19104, USA.
| | - Rosemarie Mick
- Department of Biostatistics & Epidemiology, University of Pennsylvania Perelman School of Medicine, 609 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104-6021, USA
| | - Gregory J Nadolski
- Department of Interventional Radiology, Hospital of the University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Jeffrey I Mondschein
- Department of Interventional Radiology, Hospital of the University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - S William Stavropoulos
- Department of Interventional Radiology, Hospital of the University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Michael C Soulen
- Department of Interventional Radiology, Hospital of the University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, 19104, USA
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Wang WD, Zhang LH, Ni JY, Jiang XY, Chen D, Chen YT, Sun HL, Luo JH, Xu LF. Radiofrequency Ablation Combined with Transcatheter Arterial Chemoembolization Therapy Versus Surgical Resection for Hepatocellular Carcinoma within the Milan Criteria: A Meta-Analysis. Korean J Radiol 2018; 19:613-622. [PMID: 29962868 PMCID: PMC6005934 DOI: 10.3348/kjr.2018.19.4.613] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 01/15/2018] [Indexed: 12/12/2022] Open
Abstract
Objective To meta-analytically compare combined transarterial chemoembolization (TACE) plus radiofrequency ablation (RFA) and surgical resection (SR) for the treatment of hepatocellular carcinoma (HCC) within the Milan criteria. Materials and Methods PubMed, Medline, Embase, and Cochrane Library were searched for studies comparing these two therapies that were published between January 2006 and August 2017. Overall survival rate (OS), recurrence-free survival rate (RFS), major complications and the average length of hospital stay were compared between these two therapies. Meta-analytic pooled odds ratio (OR) was calculated using TACE plus RFA as the base category. Results Seven case-control studies and one randomized trial were identified. Meta-analytic results revealed that, compared with SR, TACE plus RFA had significantly higher 1-year OS (OR for survival = 0.50, p = 0.009) and lower major complications (OR = 1.88, p = 0.02) after therapy. Three studies reported on the length of hospital stay. The average length ± standard deviation reported in individual studies for SR and TACE plus RFA groups was 19.8 ± 8.4 days and 7.4 ± 2.2 days, respectively; 18.7 ± 4.9 days and 11.5 ± 6.9 days, respectively; and 16.6 ± 6.7 days and 8.5 ± 4.1 days, respectively (p < 0.0001 for all studies). Three or 5-year OS and 1-, 3-, or 5-year RFS did not significantly differ between the two therapies. Conclusion Combined TACE plus RFA may be an alternative to SR for the treatment of patients with HCC within Milan the criteria. Non-randomized design in most of the original studies was a limitation.
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Affiliation(s)
- Wei-Dong Wang
- Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Li-Hua Zhang
- Guangdong Women an Children Hospital, Guangzhou Medical University, Guangzhou 511400, China
| | - Jia-Yan Ni
- Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Xiong-Ying Jiang
- Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Dong Chen
- Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Yao-Ting Chen
- Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Hong-Liang Sun
- Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Jiang-Hong Luo
- Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Lin-Feng Xu
- Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
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Peng Z, Wei M, Chen S, Lin M, Jiang C, Mei J, Li B, Wang Y, Li J, Xie X, Kuang M. Combined transcatheter arterial chemoembolization and radiofrequency ablation versus hepatectomy for recurrent hepatocellular carcinoma after initial surgery: a propensity score matching study. Eur Radiol 2018. [PMID: 29536241 DOI: 10.1007/s00330-017-5166-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To compare retrospectively the efficacy of transcatheter arterial chemoembolization (TACE) plus radiofrequency ablation (RFA) (TACE-RFA) with that of repeat hepatectomy in the treatment of initial recurrent hepatocellular carcinoma (HCC) after hepatectomy by propensity score matching (PSM). METHODS From September 2006 to June 2015, 186 patients who underwent TACE-RFA (n=107) or repeat hepatectomy (n=79) for recurrent HCC ≤ 5.0 cm were included. The overall survival (OS) and disease-free survival (DFS) were compared. PSM was used to correct potential confounding factors between these two groups. RESULTS 1-, 3-, and 5-year OS rates after TACE-RFA and repeat hepatectomy were 84.6%, 66.9%, 49.1%, and 84.8%, 60.2%, 51.9%, respectively (p=.871). The corresponding DFS rates were 58.2%, 35.2%, 29.6% and 64.8%, 41.6%, 38.3% (p=.258). TACE-RFA has lower major complication rates (p=.009) and shorter hospital stay (p<.001). After PSM, 1-, 3-, 5- year OS rates after TACE-RFA (n=51) and repeat hepatectomy (n=51) were 84.3%, 60.4%, 46.4% and 84.3%, 64.5%, 49.8% (p=.951), the corresponding DFS rates were 54.9%, 35.0%, 30.6% and 58.7%, 35.8%, and 33.6% (p=.733). AFP and micro-vessel invasion of initial tumour were significant prognostic factors for OS and DFS, respectively. CONCLUSIONS TACE-RFA provides comparable OS and DFS to repeat hepatectomy, fewer major complications and shorter hospital stay. KEY POINTS • TACE-RFA achieved similar OS and DFS with repeat hepatectomy for recurrent HCC • Major complication rate was lower in the TACE-RFA group • The hospital stay was shorter in the TACE-RFA group • AFP was a predictor for OS, MVI was a predictor for DFS • The treatment strategies were not significant prognostic factor for OS or DFS.
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Affiliation(s)
- Zhenwei Peng
- Department of Oncology, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou, 510080, China.,Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Mengchao Wei
- Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Shuling Chen
- Division of Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Manxia Lin
- Division of Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Chunlin Jiang
- Division of Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Jie Mei
- Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Bin Li
- Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Yu Wang
- Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Jiaping Li
- Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Xiaoyan Xie
- Division of Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Ming Kuang
- Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou, 510080, China. .,Division of Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou, 510080, China.
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Yi PS, Huang M, Zhang M, Xu L, Xu MQ. Comparison of Transarterial Chemoembolization Combined with Radiofrequency Ablation Therapy versus Surgical Resection for Early Hepatocellular Carcinoma. Am Surg 2018. [DOI: 10.1177/000313481808400238] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Both radiofrequency ablation (RFA) and surgical resection (SR) are radical treatment recommended for early hepatocellular carcinoma (HCC). Transarterial chemoembolization (TACE) is a palliative treatment for intermediate HCC, and TACE1RFA combined therapy is considered superior to TACE or RFA alone for management of early HCC. This systematic review compared the efficacy and safety of TACE1RFA combined therapy with SR for early HCC. Web of Science, PubMed, EMBASE, and the Cochrane Library were searched for literatures related with our topic. The primary endpoint was overall survival (OS), and the secondary endpoint was the recurrence-free survival (RFS) rate; safety was measured by the rate of major complications. The effect sizes of OS, RFS, and local progression rates were expressed by odds ratio (OR), while the effect size of complications was presented using relative risk. TACE1RFA combined therapy and SR had a similar 1-year OS rate [OR: 1.84; 95% confidence interval (CI): 0.82, 4.14; P > 0.05], 3-year OS rate (OR: 0.84; 95% CI: 0.43, 1.67; P > 0.05), 1-year RFS rate (OR: 0.77; 95% CI: 0.53, 1.11; P > 0.05), and 3-year RFS rate (OR: 0.88; 95% CI: 0.48, 1.42; P > 0.05) for early HCC. However, the 5-year OS rate (OR: 0.54; 95% CI: 0.40, 0.73; P < 0.05) and 5-year RFS rate (OR: 0.49; 95% CI: 0.27, 0.90; P < 0.05) were lower in patients with TACE1RFA than in those with SR. SR is associated with better long-term survival outcomes and a lower recurrence rate than TACE1RFA for patients with early HCC and is the optimal choice for patients with early HCC.
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Affiliation(s)
- Peng-Sheng Yi
- Department of hepato-biliary-pancrease, Institute of General Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China and
| | - Min Huang
- Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Zhang
- Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Liangliang Xu
- Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ming-Qing Xu
- Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu, China
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Wang W, Hou S, Zhong Z, Ni J, Jiang X, Chen D, Chen Y, Luo J, Sun H, Xu L. Radiofrequency ablation combined with transcatheter arterial chemoembolization therapy versus surgical resection for Barcelona-Clinic Liver Cancer (BCLC) A hepatocellular carcinoma: a meta-analysis. J Interv Med 2018; 1:49-57. [PMID: 35586344 PMCID: PMC8607463 DOI: 10.19779/j.cnki.2096-3602.2018.01.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose: The objective of our study was to compare the effectiveness of the combination of transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA) with that of surgical resection (SR) in Barcelona-Clinic Liver Cancer (BCLC) A hepatocellular carcinoma. Materials and Methods: PubMed, Medline, Embase, and Cochrane Library were searched for comparisons of the two therapies from January 2006 to December 2017. Overall survival rate (OS), recurrence-free survival rate (RFS), complications, and the average length of hospital stay were compared and analyzed. Review Manager v. 5.2 from the Cochrane Collaboration was used for statistical analyses. Results: Seven case-control studies and one randomized controlled trial were identified, of which 717 were treated with a combination of TACE and RFA and 785 were treated with SR. Meta-analysis data revealed that TACE plus RFA had significantly better effectiveness on 1.0-y OS (OR = 0.50, p = .009). The major complications (ORcomplications = 1.88, p = .02) after the combined therapy were significantly lower than those after SR. There were three studies that reported the average length of hospital stay. The hospital stay for the SR group vs the combined therapy group was 19.8 ± 8.4 d vs 7.4 ± 2.2 d, respectively (p < .0001); 18.7 ± 4.9 d vs 11.5 ± 6.9 d, respectively (p < .0001); and 16.6 ± 6.7 d vs 8.5 ± 4.1 d, respectively (p < .0001). There was no significant difference in 3.0- or 5.0-y OS and 1.0-, 3.0-, or 5.0-y RFS. Conclusion: The combination of TACE and RFA has advantages in improving 1.0-y OS, reducing complications, and shortening the length of hospital stay over that of SR in the treatment of patients with BCLC A HCC.
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Affiliation(s)
- Weidong Wang
- Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University. No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong Province, China
| | - Sinan Hou
- Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University. No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong Province, China
| | - Zelong Zhong
- Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University. No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong Province, China
| | - JiaYan Ni
- Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University. No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong Province, China
| | - Xiongying Jiang
- Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University. No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong Province, China
| | - Dong Chen
- Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University. No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong Province, China
| | - Yaoting Chen
- Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University. No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong Province, China
| | - Jianghong Luo
- Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University. No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong Province, China
| | - Hongliang Sun
- Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University. No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong Province, China
| | - Linfeng Xu
- Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University. No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong Province, China
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Yan JY, Zhang JL, Wang MQ, Yuan K, Bai YH, Wang Y, Xin HN, Wang ZJ, Liu FY, Duan F, Fu JX. Combined transcatheter arterial chemoembolization and radiofrequency ablation in single-session for solitary hepatocellular carcinoma larger than 7 cm. Asia Pac J Clin Oncol 2017; 14:300-309. [PMID: 29124894 DOI: 10.1111/ajco.12817] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/22/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Jie-Yu Yan
- Department of Interventional Radiology; Chinese PLA General Hospital; Beijing China
| | - Jin-Long Zhang
- Department of Interventional Radiology; Chinese PLA General Hospital; Beijing China
- School of Medicine; Nankai University; Tianjin China
| | - Mao-Qiang Wang
- Department of Interventional Radiology; Chinese PLA General Hospital; Beijing China
| | - Kai Yuan
- Department of Interventional Radiology; Chinese PLA General Hospital; Beijing China
| | - Yan-Hua Bai
- Department of Interventional Radiology; Chinese PLA General Hospital; Beijing China
| | - Yan Wang
- Department of Interventional Radiology; Chinese PLA General Hospital; Beijing China
| | - Hai-Nan Xin
- Department of Interventional Radiology; Chinese PLA General Hospital; Beijing China
| | - Zhi-Jun Wang
- Department of Interventional Radiology; Chinese PLA General Hospital; Beijing China
| | - Feng-Yong Liu
- Department of Interventional Radiology; Chinese PLA General Hospital; Beijing China
| | - Feng Duan
- Department of Interventional Radiology; Chinese PLA General Hospital; Beijing China
| | - Jin-Xin Fu
- Department of Interventional Radiology; Chinese PLA General Hospital; Beijing China
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Meyer C, Pieper CC, Ahmadzadehfar H, Lampe NA, Matuschek EME, Maschke TA, Enkirch SJ, Essler M, Spengler U, Schild HH. Yttrium-90 radioembolization of unresectable hepatocellular carcinoma - a single center experience. Onco Targets Ther 2017; 10:4773-4785. [PMID: 29033589 PMCID: PMC5628695 DOI: 10.2147/ott.s137519] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To determine the value of radioembolization (RE) for treatment of unresectable hepatocellular carcinoma (HCC). PATIENTS AND METHODS Records of patients undergoing RE for unresectable HCC were retrospectively reviewed. Biochemical and clinical toxicities, imaging response (according to modified Response Evaluation Criteria In Solid Tumors), time-to-progression (TTP) and overall survival (OS) were analyzed. Data were stratified according to clinical and procedural parameters. Univariate and multivariate analyses were performed. RESULTS One hundred and fifteen patients (89 male, mean age 69.3 years) underwent 158 REs (119 resin-, 39 glass-based) (Barcelona Clinic Liver Cancer [BCLC]-A: 6.1%, B: 33.9%, C: 60.0%). Median clinical follow-up was 5.9 (0.9-83.5) months. No grade 4 or 5 clinical toxicities were noted. Objective response rate was 35.6%; disease control rate was 76.7%. Median TTP of the treated part of the liver was 4 (0.9-45.4) months. 108/115 patients died during follow-up (median OS 8.4 [0.3-82.8] months after first RE [BCLC-A: 52.8 months, BCLC-B: 12.4 months, BCLC-C: 6.1 months]). On multivariate analysis, baseline Eastern Co-operative Oncology Group status <1, ascites prior to RE and best imaging response were predictors of longer OS. In BCLC-C patients, tumor burden, ascites prior to RE, baseline gamma-glutamyltransferase and Child-Pugh score were predictive of OS. CONCLUSIONS RE is safe and effective in carefully selected patients suffering from HCC with a low complication rate. Low baseline Eastern Co-operative Oncology Group status and absence of ascites prior to RE are positive prognostic factors.
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Affiliation(s)
- Carsten Meyer
- Department of Radiology, University of Bonn, Sigmund-Freud-Strasse, Bonn, Germany
| | | | - Hojjat Ahmadzadehfar
- Department of Nuclear Medicine, University of Bonn, Sigmund-Freud-Strasse, Bonn, Germany
| | - Nina Alexandra Lampe
- Department of Radiology, University of Bonn, Sigmund-Freud-Strasse, Bonn, Germany
| | | | | | - Simon Jonas Enkirch
- Department of Radiology, University of Bonn, Sigmund-Freud-Strasse, Bonn, Germany
| | - Markus Essler
- Department of Nuclear Medicine, University of Bonn, Sigmund-Freud-Strasse, Bonn, Germany
| | - Ulrich Spengler
- Department of Internal Medicine I, University of Bonn, Sigmund-Freud-Strasse, Bonn, Germany
| | - Hans Heinz Schild
- Department of Radiology, University of Bonn, Sigmund-Freud-Strasse, Bonn, Germany
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30
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Lee HJ, Kim JW, Hur YH, Shin SS, Heo SH, Cho SB, Kang YJ, Lim HS, Seon HJ, Jeong YY. Combined Therapy of Transcatheter Arterial Chemoembolization and Radiofrequency Ablation versus Surgical Resection for Single 2–3 cm Hepatocellular Carcinoma: A Propensity-Score Matching Analysis. J Vasc Interv Radiol 2017; 28:1240-1247.e3. [DOI: 10.1016/j.jvir.2017.05.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/18/2017] [Accepted: 05/22/2017] [Indexed: 12/31/2022] Open
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31
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Thein H, Isaranuwatchai W, Qiao Y, Wong K, Sapisochin G, Chan KKW, Yoshida EM, Earle CC. Cost-effectiveness analysis of potentially curative and combination treatments for hepatocellular carcinoma with person-level data in a Canadian setting. Cancer Med 2017; 6:2017-2033. [PMID: 28791798 PMCID: PMC5603843 DOI: 10.1002/cam4.1119] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 02/21/2017] [Accepted: 05/03/2017] [Indexed: 12/12/2022] Open
Abstract
Patients with early-stage hepatocellular carcinoma (HCC) are potential candidates for curative treatments such as radiofrequency ablation (RFA), surgical resection (SR), or liver transplantation (LT), which have demonstrated a significant survival benefit. We aimed to estimate the cost-effectiveness of curative and combination treatment strategies among patients diagnosed with HCC during 2002-2010. This study used Ontario Cancer Registry-linked administrative data to estimate effectiveness and costs (2013 USD) of the treatment strategies from the healthcare payer's perspective. Multiple imputation by logistic regression was used to handle missing data. A net benefit regression approach of baseline important covariates and propensity score adjustment were used to calculate incremental net benefit to generate incremental cost-effectiveness ratio (ICER) and uncertainty measures. Among 2,222 patients diagnosed with HCC, 10.5%, 14.1%, and 10.3% received RFA, SR, and LT monotherapy, respectively; 0.5-3.1% dual treatments; and 0.5% triple treatments. Compared with no treatment (53.2%), transarterial chemoembolization (TACE) + RFA (average $2,465, 95% CI: -$20,000-$36,600/quality-adjusted life years [QALY]) or RFA monotherapy ($15,553, 95% CI: $3,500-$28,500/QALY) appears to be the most cost-effective modality with lowest ICER value. The cost-effectiveness acceptability curve showed that if the relevant threshold was $50,000/QALY, RFA monotherapy and TACE+ RFA would have a cost-effectiveness probability of 100%. Strategies using LT delivered the most additional QALYs and became cost-effective at a threshold of $77,000/QALY. Our findings found that TACE+ RFA dual treatment or RFA monotherapy appears to be the most cost-effective curative treatment for patients with potential early stage of HCC in Ontario. These findings highlight the importance of identifying and measuring differential benefits, costs, and cost-effectiveness of alternative HCC curative treatments in order to evaluate whether they are providing good value for money in the real world.
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Affiliation(s)
- Hla‐Hla Thein
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Institute for Clinical Evaluative SciencesTorontoOntarioCanada
| | - Wanrudee Isaranuwatchai
- Centre for Excellence in Economic Analysis ResearchThe HUB Li Ka Shing Knowledge InstituteSt. Michael's HospitalTorontoOntarioCanada
- Institute of Health PolicyManagement and EvaluationUniversity of TorontoTorontoOntarioCanada
| | - Yao Qiao
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Kenny Wong
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Gonzalo Sapisochin
- Multi‐Organ TransplantDivision of General SurgeryUniversity Health NetworkUniversity of TorontoTorontoOntarioCanada
| | - Kelvin K. W. Chan
- Odette Cancer CentreSunnybrook Health Sciences CentreTorontoOntarioCanada
- Department of MedicineUniversity of TorontoTorontoOntarioCanada
- Canadian Centre for Applied Research in Cancer Control (ARCC)TorontoOntarioCanada
| | - Eric M. Yoshida
- University of British ColumbiaDivision of GastroenterologyVancouverBritish ColumbiaCanada
| | - Craig C. Earle
- Institute for Clinical Evaluative SciencesTorontoOntarioCanada
- Canadian Centre for Applied Research in Cancer Control (ARCC)TorontoOntarioCanada
- Ontario Institute for Cancer ResearchTorontoOntarioCanada
- Cancer Care OntarioTorontoOntarioCanada
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Efficacy and safety of combination therapy of chemoembolization and radiofrequency ablation with different time intervals for hepatocellular carcinoma patients. Surg Oncol 2017; 26:236-241. [DOI: 10.1016/j.suronc.2017.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 04/28/2017] [Accepted: 04/30/2017] [Indexed: 01/13/2023]
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Liver Resection versus Radiofrequency Ablation plus Transcatheter Arterial Chemoembolization in Cirrhotic Patients with Solitary Large Hepatocellular Carcinoma. J Vasc Interv Radiol 2017; 28:1512-1519. [PMID: 28734848 DOI: 10.1016/j.jvir.2017.06.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 06/09/2017] [Accepted: 06/09/2017] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To compare liver resection (LR) with single-step, balloon-occluded radiofrequency (RF) ablation plus drug-eluting embolics transarterial chemoembolization in cirrhotic patients with single hepatocellular carcinoma (HCC) ≥ 3 cm. MATERIALS AND METHODS From 2010 to 2014, 25 patients with compensated cirrhosis and single HCC ≥ 3 cm (median size 4.5 cm; range, 3.0-6.8 cm) not suitable for LR or liver transplantation were treated with RF ablation plus transarterial chemoembolization in a prospective observational single-center pilot study; all patients had complete tumor necrosis after treatment. A retrospective control group included 29 patients (median HCC size 4.0 cm; range, 3.0-7.4 cm) who underwent LR. RF ablation plus transarterial chemoembolization group included more patients with severe portal hypertension (65.5% vs 35.0%, P = .017). Primary endpoints were overall survival (OS) and tumor recurrence (TR) rates. RESULTS One death and 1 major complication (4%) were observed in LR group. No major complications were reported in RF ablation plus transarterial chemoembolization group (P = .463). OS rates at 1 and 3 years were 91.8% and 79.3% in LR group and 89.4% and 48.2% in RF ablation plus transarterial chemoembolization group (P = 0.117). TR rates at 1 and 3 years were 29.5% and 45.0% in LR group and 42.4% and 76.0% in RF ablation plus transarterial chemoembolization group (P = .034). Local tumor progression (LTP) rates at 3 years were significantly lower in LR group (21.8% vs 58.1%, P = .005). Similar results were found in patients with HCC ≤ 5 cm (TR rates 35.4% vs 75.1%, P = .016; LTP 16.0% vs 55.7%, P = .013). CONCLUSIONS LR achieved lower TR and LTP rates than RF ablation plus transarterial chemoembolization, but 3-years OS rates were not statistically different between the 2 groups. RF ablation plus transarterial chemoembolization is an effective treatment option in patients with compensated cirrhosis and solitary HCC ≥ 3 cm unsuitable for LR.
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Bholee AK, Peng K, Zhou Z, Chen J, Xu L, Zhang Y, Chen M. Radiofrequency ablation combined with transarterial chemoembolization versus hepatectomy for patients with hepatocellular carcinoma within Milan criteria: a retrospective case-control study. Clin Transl Oncol 2017; 19:844-852. [PMID: 28070766 DOI: 10.1007/s12094-016-1611-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 12/31/2016] [Indexed: 01/01/2023]
Abstract
PROPOSAL To compare the effectiveness of TACE + RFA with hepatectomy in patients with HCC within Milan criteria. METHODS It is a retrospective matched case-control study from January 2006 to December 2010 in a tertiary cancer center. 74 patients with HCC within Milan criteria initially treated with TACE + RFA were identified and compared with 148 matched controls selected from a pool of 782 patients who received hepatectomy. Patients were matched with respect to age, gender, tumor size and number, AFP and liver function test. RESULTS The 1, 3, and 5 years overall survival (OS) was 94.6, 75.1 and 55.3%, respectively, in the combination group, and 91.2, 64.4, and 47.7%, respectively, in the hepatectomy group (P = 0.488). The 1, 3, and 5 years disease-free survival (DFS) in the combination group was 87.8, 48.3, and 33.5%, respectively, and 68.9, 49.2, and 40.9%, respectively, in the hepatectomy group (P = 0.619). In subgroups analyses according to the tumor size and number, no significant difference was identified in either OS or DFS for patients with single tumor smaller than 3.0 cm, 3.0-5.0 cm, and multiple tumors. Multivariate analysis showed that tumor size, ALT, and CLIP score were significant prognostic factors for OS, and ALT and Child-Pugh class were significant prognostic factors for DFS. CONCLUSION TACE + RFA is safe and as effective as hepatectomy for patients with HCC within Milan criteria.
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Affiliation(s)
- A K Bholee
- Department of Hepatobiliary Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - K Peng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China.,Department of Radiology, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Z Zhou
- Department of Hepatobiliary Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - J Chen
- Department of Hepatobiliary Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - L Xu
- Department of Hepatobiliary Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Y Zhang
- Department of Hepatobiliary Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China. .,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China.
| | - M Chen
- Department of Hepatobiliary Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China. .,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China.
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Liang HY, Guo QY, Sun W, Mao XN, Wen F, Shan M, Zhao G, Wang XH, Lu ZM. Sequential Use of Transhepatic Arterial Chemoembolization and Bipolar Radiofrequency Ablation in the Clinical Therapy of Hepatocellular Carcinoma. Cancer Biother Radiopharm 2016; 30:427-32. [PMID: 26683133 DOI: 10.1089/cbr.2015.1884] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
This retrospective study investigated the clinical application of sequential therapy with transarterial chemoembolization (TACE) and CT-guided radiofrequency ablation (RFA) using a bipolar needle in treating hepatocellular carcinoma (HCC) tumors of different sizes. The study included patients (N = 46) with HCC from Shengjing Hospital of China Medical University who had received TACE and RFA from November 2012 to November 2013. Eligible patients had an Eastern Cooperative Oncology Group (ECOG) score of 0-1, a Child-Pugh grade of A-B, and no contradictions for TACE and/or RFA. Fifty one hepatic lesions of varying sizes were treated with TACE followed by RFA. Clinical response and 1- and 2-year survival rates were assessed. The frequency of complete and incomplete ablation following therapy was significantly different across the varying RFA pin numbers and the maximum diameter of the lesion (p ≤ 0.001). A greater percentage (97.3%) of lesions that were ≤3 cm in diameter were completely ablated compared with lesions that were 3-5 cm (88.9%) and >5 cm in diameter (20%). The median survival time of patients was 16.5 months, and the 1- and 2-year survival rates were 95.7% and 69.3%, respectively. There were only a limited number of complications, all of which were minor. These included hemothorax (4.3%), abdominal hemorrhage (10.9%), and abdominal hemorrhage with minor pneumothorax (2.2%). This study found that the sequential treatment with TACE and CT-guided RFA using a bipolar needle is effective and well tolerated in patients with HCC and that the effectiveness of treatment is dependent on tumor size.
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Affiliation(s)
- Hong-Yuan Liang
- Department of Radiology, China Medical University Shengjing Hospital , Shenyang, China
| | - Qi-Yong Guo
- Department of Radiology, China Medical University Shengjing Hospital , Shenyang, China
| | - Wei Sun
- Department of Radiology, China Medical University Shengjing Hospital , Shenyang, China
| | - Xiao-Nan Mao
- Department of Radiology, China Medical University Shengjing Hospital , Shenyang, China
| | - Feng Wen
- Department of Radiology, China Medical University Shengjing Hospital , Shenyang, China
| | - Ming Shan
- Department of Radiology, China Medical University Shengjing Hospital , Shenyang, China
| | - Gang Zhao
- Department of Radiology, China Medical University Shengjing Hospital , Shenyang, China
| | - Xi-Hai Wang
- Department of Radiology, China Medical University Shengjing Hospital , Shenyang, China
| | - Zai-Ming Lu
- Department of Radiology, China Medical University Shengjing Hospital , Shenyang, China
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36
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Tang CW, Zhu M, Feng WM, Bao Y, Zheng YY. Chinese herbal medicine, Jianpi Ligan decoction, improves prognosis of unresectable hepatocellular carcinoma after transarterial chemoembolization: a retrospective study. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 10:2461-6. [PMID: 27536066 PMCID: PMC4977068 DOI: 10.2147/dddt.s113295] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective This study aimed to investigate the efficacy of Jianpi Ligan decoction (JLD) as an adjuvant therapy for patients with unresectable hepatocellular carcinoma (HCC) treated by transarterial chemoembolization (TACE). Methods From March 2007 to March 2013, 103 patients with unresectable HCC who underwent TACE in our center were included in this retrospective study. Among the 103 patients, 53 patients accepted JLD along with TACE (JLD group) and 50 patients accepted TACE alone (control group). Indices including complication, toxicity, treatment success rate, and long-term survival were obtained for analysis and comparison. Results There was no significant difference in patient characteristics between the two groups. No procedure-related deaths or encephalopathy occurred. Fewer patients from the JLD group experienced constipation (7/53 vs 15/50, P=0.0377), abdominal bloating (5/53 vs 12/50, P=0.0466), and lack of appetite (35/53 vs 42/50, P=0.0360). The JLD group had lesser and lighter hepatic toxicity (P=0.0265) and gastrointestinal toxicity (P=0.0445) such as nausea and vomiting. The JLD group had a significantly higher treatment success rate than the control group (51/53 vs 40/50, P=0.0103). Three-year overall survival probability was significantly higher in the JLD group than in the control group (37.74% vs 26.00%; hazard ratio [HR] 0.6171; 95% confidence interval [CI], 0.3832–0.9938; P=0.0365 by log-rank test). No significant difference was found in 3-year overall survival probability (39.22% vs 32.50%; HR, 0.7449; 95% CI, 0.4398–1.2614; P=0.2491 by log-rank test) or 3-year intrahepatic recurrence-free survival probability in patients who achieved treatment success (37.25% vs 30.00%; HR, 0.7280; 95% CI, 0.4332–1.2233; P=0.2087 by log-rank test) between the two groups. Conclusion Application of JLD was effective for reduction of side effects and improvement of long-term survival for patients with unresectable HCC treated by TACE.
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Affiliation(s)
| | | | | | | | - Yin Yuan Zheng
- Department of Radiology, First People's Hospital Affiliated to Huzhou University Medical College, Huzhou, People's Republic of China
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Tang C, Shen J, Feng W, Bao Y, Dong X, Dai Y, Zheng Y, Zhang J. Combination Therapy of Radiofrequency Ablation and Transarterial Chemoembolization for Unresectable Hepatocellular Carcinoma: A Retrospective Study. Medicine (Baltimore) 2016; 95:e3754. [PMID: 27196501 PMCID: PMC4902444 DOI: 10.1097/md.0000000000003754] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The treatment efficacy of unresectable hepatocellular carcinoma (HCC) is still not promising. This study aimed to compare the efficacy and safety of radiofrequency ablation (RFA) combined with transarterial chemoembolization (TACE) for unresectable HCC with a single treatment.Between June 2009 and June 2012, 132 patients who were diagnosed with unresectable HCC and accepted nonsurgical treatments in our center were enrolled in this retrospective study. On the basis of treatment modality, they were allocated to 3 groups: 49 patients accepted RFA (RFA group); 43 patients accepted TACE (TACE group); and 40 patients accepted RFA following TACE (combination group). Clinical data including complications, treatment success rate, hospitalization costs, intrahepatic recurrence-free survival, overall survival, and factors influencing survival were retrospectively analyzed.Patient characteristics between these groups showed no significant difference. Treatment success was achieved in all patients of 3 groups. The combination group had a significantly higher total hospitalization cost to treatment than the TACE group (63,708.14 ± 9193.81 Chinese yuan vs 37,534.88 ± 6802.84 Chinese yuan; P = 0.0000). All complications were controllable and no permanent adverse sequelae or procedure-related deaths were observed. The 3-year intrahepatic recurrence-free survival probability was significantly better in the combination group than in the TACE group (42.50% vs 20.93%; hazard ratio [HR], 0.5105; 95% confidence interval [CI], 0.3022-0.8625; P = 0.0094) or the RFA group (42.50% vs 22.45%; HR, 0.5233; 95% CI, 0.3149-0.8697; P = 0.0111).The 3-year overall survival probability was significantly better in the combination group than in the TACE group (45.00% vs 26.53%; HR, 0.5069; 95% CI, 0.2936-0.8752; P = 0.0100) or the RFA group (45.00% vs 27.91%; HR, 0.4913; 95% CI, 0.2928-0.8246; P = 0.0054). Main tumor size, number of tumors, and treatment modality were demonstrated to be important factors associated with 3-year intrahepatic recurrence-free survival probability and overall survival probability (P < 0.05) by univariate and multivariate analyses.Combination therapy of RFA and TACE was superior to TACE alone or RFA alone in improving survival for patients with unresectable HCC.
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Affiliation(s)
- Chengwu Tang
- From the Department of General Surgery, The Second Affiliated Hospital, Nanjing Medical University, Nanjing (CT, JS, XD, YD, JZ) and Departments of General Surgery (CT, WF, YB) and Radiology (YZ), First People's Hospital Affiliated to Huzhou University Medical College, Huzhou, China
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Kan XF, Wang Y, Lin GC, Xia XW, Xiong B, Zhou GF, Liang HM, Feng GS, Zheng CS. Radiofrequency ablation combined with transarterial chemoembolization for liver metastases from gastrointestinal cancers. ACTA ACUST UNITED AC 2016; 36:200-204. [DOI: 10.1007/s11596-016-1566-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 12/23/2015] [Indexed: 01/21/2023]
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39
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Azuma S, Asahina Y, Nishimura-Sakurai Y, Kakinuma S, Kaneko S, Nagata H, Goto F, Ootani S, Kawai-Kitahata F, Taniguchi M, Murakawa M, Watanabe T, Tasaka-Fujita M, Itsui Y, Nakagawa M, Watanabe M. Efficacy of additional radiofrequency ablation after transcatheter arterial chemoembolization for intermediate hepatocellular carcinoma. Hepatol Res 2016. [PMID: 26224167 DOI: 10.1111/hepr.12566] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM For intermediate hepatocellular carcinoma (HCC), transcatheter arterial chemoembolization (TACE) therapy is recommended in the guidelines as a monotherapy, although TACE is a non-curative therapy. The aims of the present study were to evaluate the efficacy of adding radiofrequency ablation (RFA) to TACE in patients with intermediate HCC, and to identify the factors that were associated with favorable survival in these patients. METHODS Fifty-nine patients with intermediate HCC were enrolled in this retrospective study. Thirty-nine patients were treated with TACE alone and 20 patients were treated with additional RFA after TACE. RESULTS The recurrence-free survival rates at 0.5, 1 and 2 years for the additional RFA group were 32%, 19% and 13%, respectively, and these were significantly higher than those of the TACE group (8%, 3% and 0%, respectively; log-rank test, P = 0.001). The cumulative survival rates of the additional RFA group were significantly higher than those of the TACE group (log-rank test, P = 0.002), although this significant difference was not found in the subgroup of treatment naive patients because of small sample size. Multivariate analysis indicated male sex, lower total bilirubin, lower α-fetoprotein, lower des-γ-carboxyprothrombin, newly recurrent HCC nodules within the last 12 months and additional RFA as independent factors that were significantly associated with favorable overall survival. CONCLUSION Additional RFA of nodules insufficiently treated by TACE is effective therapy for obtaining favorable disease-free survival in patients with intermediate HCC, and leads to better overall survival particularly in recurrent patients.
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Affiliation(s)
- Seishin Azuma
- Departments of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhiro Asahina
- Departments of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Liver Disease Control, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuki Nishimura-Sakurai
- Departments of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sei Kakinuma
- Departments of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Liver Disease Control, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shun Kaneko
- Departments of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroko Nagata
- Departments of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Fumio Goto
- Departments of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Satoshi Ootani
- Departments of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Fukiko Kawai-Kitahata
- Departments of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Miki Taniguchi
- Departments of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Miyako Murakawa
- Departments of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takako Watanabe
- Departments of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Megumi Tasaka-Fujita
- Departments of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhiro Itsui
- Departments of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mina Nakagawa
- Departments of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mamoru Watanabe
- Departments of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
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Song MJ, Bae SH, Lee JS, Lee SW, Song DS, You CR, Choi JY, Yoon SK. Combination transarterial chemoembolization and radiofrequency ablation therapy for early hepatocellular carcinoma. Korean J Intern Med 2016; 31:242-52. [PMID: 26874512 PMCID: PMC4773726 DOI: 10.3904/kjim.2015.112] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 08/13/2014] [Accepted: 11/18/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND/AIMS We compared the recurrence of hepatocellular carcinoma (HCC) and the survival of patients who received radiofrequency ablation (RFA) after transarterial chemoembolization (TACE) with patients treated with TACE or RFA alone. METHODS This study included 201 patients with HCC, who were consecutively enrolled at Seoul St. Mary's Hospital between December 2004 and February 2010. Inclusion criteria were a single HCC ≤ 5.0 cm or up to three HCCs ≤ 3.0 cm. We used a propensity score model to compare HCC patients (n = 87) who received RFA after TACE (TACE + RFA) with those who received TACE (n = 71) or RFA alone (n = 43). RESULTS The median follow-up period was 33.3 months (range, 6.8 to 80.9). The TACE + RFA group showed significantly lower local recurrence than the RFA or TACE groups (hazard ratio [HR], 0.309; 95% confidence interval [CI], 0.130 to 0.736; p = 0.008; and HR, 0.352; 95% CI, 0.158 to 0.787; p = 0.011, respectively). The overall survival was significantly better in the TACE + RFA group compared to the RFA group (HR, 0.422; 95% CI, 0.185 to 0.964; p = 0.041). However, the survival benefit was not different between the TACE + RFA and TACE groups (p = 0.124). Subgroup analysis showed that among patients with a tumor size < 3 cm, the TACE + RFA group had significantly better long-term survival than those in the TACE or RFA groups (p = 0.017, p = 0.004, respectively). CONCLUSIONS TACE + RFA combination treatment showed favorable local recurrence and better overall survival rates in early-stage HCC patients. Patients with tumors < 3 cm are likely to benefit more from TACE + RFA combination treatment. Additional studies are needed for the selection of suitable HCC patients for TACE + RFA treatment.
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Affiliation(s)
- Myeong Jun Song
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Si Hyun Bae
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - June Sung Lee
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Sung Won Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Do Seon Song
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chan Ran You
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Correspondence to Chan Ran You, M.D. Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea Tel: +82-2-2258-2073 Fax: +82-2-3481-4025 E-mail:
| | - Jong Young Choi
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Kew Yoon
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Paik EK, Kim MS, Jang WI, Seo YS, Cho CK, Yoo HJ, Han CJ, Park SC, Kim SB, Kim YH. Benefits of stereotactic ablative radiotherapy combined with incomplete transcatheter arterial chemoembolization in hepatocellular carcinoma. Radiat Oncol 2016; 11:22. [PMID: 26896371 PMCID: PMC4759954 DOI: 10.1186/s13014-016-0597-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 02/01/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the effect of stereotactic ablative radiotherapy (SABR) after incomplete transcatheter arterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) patients. METHODS The study enrolled 178 HCC patients initially treated with TACE between 2006 and 2011. Patients were included if they had Barcelona Clinic Liver Cancer stage 0 or A, ≤3 nodules with a total sum of longest diameter ≤10 cm, Child-Turcotte-Pugh score of ≤7, no major vessel invasion, and no extra-hepatic metastases. RESULTS Twenty-four patients achieved a complete response to TACE (group 1). Among those with incomplete response, 47 patients received other curative treatments (group 2), 37 received SABR (group 3), and 70 received non-curative treatments (group 4). The 2-year overall survival (OS) rates for groups 1, 2, 3, and 4 were 88 %, 81 %, 73 %, and 54 %, respectively. The corresponding 5-year OS rates were 50 %, 58 %, 53 %, and 28 %, respectively. CONCLUSIONS Patients treated with SABR after incomplete TACE had similar survival outcomes to those achieving complete response to TACE or receiving curative treatments. However, patients receiving non-curative treatments had significantly lower survival rates than the other groups. Therefore, if SABR was indicated at the initial diagnosis, it might be recommended after TACE failure.
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Affiliation(s)
- Eun Kyung Paik
- Department of Radiation Oncology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, 75 Nowon-ro, Nowon-gu, Seoul, Republic of Korea.
| | - Mi-Sook Kim
- Department of Radiation Oncology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, 75 Nowon-ro, Nowon-gu, Seoul, Republic of Korea.
| | - Won Il Jang
- Department of Radiation Oncology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, 75 Nowon-ro, Nowon-gu, Seoul, Republic of Korea.
| | - Young Seok Seo
- Department of Radiation Oncology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, 75 Nowon-ro, Nowon-gu, Seoul, Republic of Korea.
| | - Chul-Koo Cho
- Department of Radiation Oncology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, 75 Nowon-ro, Nowon-gu, Seoul, Republic of Korea.
| | - Hyung Jun Yoo
- Department of Radiation Oncology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, 75 Nowon-ro, Nowon-gu, Seoul, Republic of Korea.
| | - Chul Ju Han
- Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea.
| | - Su Cheol Park
- Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea.
| | - Sang Bum Kim
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea.
| | - Young Han Kim
- Department of Radiology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea.
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Iezzi R, Pompili M, Posa A, Coppola G, Gasbarrini A, Bonomo L. Combined locoregional treatment of patients with hepatocellular carcinoma: State of the art. World J Gastroenterol 2016; 22:1935-1942. [PMID: 26877601 PMCID: PMC4726669 DOI: 10.3748/wjg.v22.i6.1935] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 12/30/2015] [Indexed: 02/06/2023] Open
Abstract
In recent years, a combination of intervention therapies has been widely applied in the treatment of hepatocellular carcinoma (HCC). One such combined strategy is based on the combination of the percutaneous approach, such as radiofrequency ablation (RFA), and the intra-arterial locoregional approach, such as trans-arterial chemoembolization (TACE). Several types of evidence have supported the feasibility and benefit of combined therapy, despite some studies reporting conflicting results and outcomes. The aim of this review was to explain the technical aspects of different combined treatments and to comprehensively analyze and compare the clinical efficacy and safety of this combined treatment option and monotherapy, either as TACE or RFA alone, in order to provide clinicians with an unbiased opinion and valuable information. Based on a literature review and our experience, combined treatment seems to be a safe and effective option in the treatment of patients with early/intermediate HCC when surgical resection is not feasible; furthermore, this approach provides better results than RFA and TACE alone for the treatment of large HCC, defined as those exceeding 3 cm in size. It can also expand the indication for RFA to previously contraindicated “complex cases”, with increased risk of thermal ablation related complications due to tumor location, or to “complex patients” with high bleeding risk.
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Liu H, Wang ZG, Fu SY, Li AJ, Pan ZY, Zhou WP, Lau WY, Wu MC. Randomized clinical trial of chemoembolization plus radiofrequency ablation versus partial hepatectomy for hepatocellular carcinoma within the Milan criteria. Br J Surg 2016; 103:348-56. [PMID: 26780107 DOI: 10.1002/bjs.10061] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 10/14/2015] [Accepted: 10/23/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND This study aimed to compare sequential treatment by transcatheter arterial chemoembolization (TACE) and percutaneous radiofrequency ablation (RFA) with partial hepatectomy for hepatocellular carcinoma (HCC) within the Milan criteria. METHODS In a randomized clinical trial, patients with HCC within the Milan criteria were included and randomized 1 : 1 to the partial hepatectomy group or the TACE + RFA group. The primary outcome was overall survival and the secondary outcome was recurrence-free survival. RESULTS Two hundred patients were enrolled. The 1-, 3- and 5-year overall survival rates were 97·0, 83·7 and 61·9 per cent for the partial hepatectomy group, and 96·0, 67·2 and 45·7 per cent for the TACE + RFA group (P = 0·007). The 1-, 3- and 5-year recurrence-free survival rates were 94·0, 68·2 and 48·4 per cent, and 83·0, 44·9 and 35·5 per cent respectively (P = 0·026). On Cox proportional hazard regression analysis, HBV-DNA (hazard ratio (HR) 1·76; P = 0·006), platelet count (HR 1·00; P = 0·017) and tumour size (HR 1·90; P < 0·001) were independent prognostic factors for recurrence-free survival, and HBV-DNA (HR 1·61; P = 0·036) was a risk factor for overall survival. The incidence of complications in the partial hepatectomy group was higher than in the TACE + RFA group (23·0 versus 11·0 per cent respectively; P = 0·024). CONCLUSION For patients with HCC within the Milan criteria, partial hepatectomy was associated with better overall and recurrence-free survival than sequential treatment with TACE and RFA. REGISTRATION NUMBER ACTRN12611000770965 (http://www.anzctr.org.au/).
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Affiliation(s)
- H Liu
- Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Z-G Wang
- Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - S-Y Fu
- Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - A-J Li
- Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Z-Y Pan
- Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - W-P Zhou
- Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - W-Y Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - M-C Wu
- Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
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Yune Y, Kim S, Song I, Chun K. Comparative analysis of intraoperative radiofrequency ablation versus non-anatomical hepatic resection for small hepatocellular carcinoma: short-term result. KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2015; 19:173-80. [PMID: 26693237 PMCID: PMC4683920 DOI: 10.14701/kjhbps.2015.19.4.173] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 11/04/2015] [Accepted: 11/08/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUNDS/AIMS To compare the clinical outcomes of intraoperative radiofrequency ablation (RFA) and non-anatomical hepatic resection (NAHR) for small hepatocellular carcinoma (HCC). METHODS From February 2007 to January 2015, clinical outcomes of thirty four patients with HCC receiving RFA or NAHR were compared, retrospectively. RESULTS There was no difference of patient and tumor characteristic between the two groups that received RFA or NAHR. The 1, 2, and 3-year recurrence rates following RFA were 32.2%, 32.2% and 59.3% respectively, and 6.7%, 33.3% and 33.3% following NAHR respectively (p=0.287). The 1, 2 and 3-year overall survival (OS) rates following RFA were 100%, 88.9% and 76.2% respectively, and 100%, 85.6% and 85.6%, respectively, following NAHR (p=0.869). We did not find a definite statistical difference in recurrence rate and OS rate between the two groups. In the multivariate analysis, number of tumor was an independent prognostic factor for recurrence and albumin was an independent prognostic factor for OS. CONCLUSIONS We recommend non-anatomical hepatic resection rather than intraoperative RFA in small sized HCC, due to a higher recurrence rate in intraoperative RFA. Intraoperative RFA was inferior to non-anatomical hepatic resection in terms of recurrence rate. We need to select the optimal treatment considering liver function and possibility of recurrence.
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Affiliation(s)
- Yongwoo Yune
- Department of surgery, Chungnam National University Hospital, Daejeon, Korea
| | - Seokwhan Kim
- Department of surgery, Chungnam National University Hospital, Daejeon, Korea
| | - Insang Song
- Department of surgery, Chungnam National University Hospital, Daejeon, Korea
| | - Kwangsik Chun
- Department of surgery, Chungnam National University Hospital, Daejeon, Korea
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Li S, Zhang L, Huang ZM, Wu PH. Transcatheter arterial chemoembolization combined with CT-guided percutaneous thermal ablation versus hepatectomy in the treatment of hepatocellular carcinoma. CHINESE JOURNAL OF CANCER 2015; 34:254-63. [PMID: 26063407 PMCID: PMC4593381 DOI: 10.1186/s40880-015-0023-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 04/09/2015] [Indexed: 12/22/2022]
Abstract
Introduction Transcatheter arterial chemoembolization (TACE) plus thermal ablation has been widely used recently in the treatment of hepatocellular carcinoma (HCC). In this study, we aimed to compare results of the combination of TACE and percutaneous thermal ablation with those of hepatectomy in patients with HCC. Methods The clinical data of 137 HCC patients who sequentially received TACE and computed tomography (CT)-guided percutaneous thermal ablation as an initial curative treatment (combination group) and 148 matched HCC patients who received hepatectomy (surgery group) between 2004 and 2011 were collected and analyzed. After TACE, multiphase contrast-enhanced CT was performed to identify the total number of tumors as well as lipiodol deposition in the liver. Survival was calculated by using the Kaplan-Meier method and compared by using the log-rank test. The prognostic factors were assessed with multivariate Cox proportional hazards regression analysis. Results Of all 285 patients, 225 (79.0 %) had cancerous lesions ≤ 5 cm in diameter. In preoperative contrast-enhanced CT or magnetic resonance imaging, the number of tumors was 1–4 for each patient. The 1-, 3-, and 5-year overall survival rates were 95, 74 %, and 67 % in the combination group and 88, 66, and 47 % in the surgery group, respectively (P = 0.004); the corresponding recurrence-free survival rates for the two groups were 92, 69, and 61 % and 75, 58, and 44 %, respectively (P = 0.001). In the multivariate analysis, treatment allocation was an independent prognostic factor for survival. Only 60 patients in the combination group had sufficient imaging data, and 135 new lesions with lipiodol deposition were diagnosed as malignancies in 22 of 60 patients, whereas 20 new lesions were found in 11 of 148 patients in the surgery group. Conclusion The combination of TACE and CT-guided percutaneous thermal ablation for HCC improves survival of HCC patients compared with hepatectomy.
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Affiliation(s)
- Sheng Li
- Department of Medical Imaging & Interventional Radiology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, People's Republic of China.
| | - Liang Zhang
- Department of Medical Imaging & Interventional Radiology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, People's Republic of China.
| | - Zhi-Mei Huang
- Department of Medical Imaging & Interventional Radiology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, People's Republic of China.
| | - Pei-Hong Wu
- Department of Medical Imaging & Interventional Radiology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, People's Republic of China.
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Ito T, Okubo H, Kokubu S, Miyazaki A, Ando H, Fujimura A, Watanabe S. Radiofrequency ablation combined with chemolipiodolization in a porcine liver: Comparison of the pharmacokinetic analysis with cisplatin powder and miriplatin. Hepatol Res 2015; 45:589-94. [PMID: 25040841 DOI: 10.1111/hepr.12387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 06/25/2014] [Accepted: 06/01/2014] [Indexed: 02/08/2023]
Abstract
AIM To compare the pharmacokinetics of radiofrequency (RF) ablation with chemolipiodolization using cisplatin (CDDP) powder and miriplatin (MPT) in a porcine liver. METHODS Twelve pigs were divided equally into four groups. After each CDDP powder-lipiodol suspension (n = 6; groups A and B) or MPT-lipiodol suspension (n = 6; groups C and D) was injected into the lateral left artery, one RF ablation was performed at the lateral left lobe of each pig. Six pigs (groups A and C) were killed on the same day as treatment, whereas the other pigs (groups B and D) were killed 7 days after the treatment. The platinum concentrations in venous blood were assayed at 15, 60 and 120 min, and 7 days after treatment. The platinum concentrations in the ablated area and the surrounding liver were also examined. RESULTS Plasma platinum concentrations of the CDDP group peaked at 15 min, and then gradually diminished over time (μg units), while plasma platinum levels in the MPT group gradually increased over time (ng units). Liver tissue platinum concentrations of the CDDP group were significantly lower in non-ablative areas than in ablated areas at days 0 and 7, while liver concentrations of the MPT group were significantly higher in non-ablative areas than in ablated areas at day 7. CONCLUSION MPT may be a suitable chemotherapeutic agent to stagnate platinum in the surrounding liver.
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Affiliation(s)
- Tomoyasu Ito
- Department of Gastroenterology, Juntendo University Nerima Hospital, Tokyo, Japan
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Choi SJ, Kim J, Seo J, Kim HS, Lee JM, Park H. Parametric response mapping of dynamic CT as an imaging biomarker to distinguish viability of hepatocellular carcinoma treated with transcatheter arterial chemoembolization. ACTA ACUST UNITED AC 2015; 39:518-25. [PMID: 24519566 DOI: 10.1007/s00261-014-0087-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Accurate assessment of viability of hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) is important for therapy planning. The purpose of this study is to determine the diagnostic value of a novel image analysis method called parametric response mapping (PRM) in predicting viability of tumor in HCC treated with TACE for dynamic CT images. METHODS 35 patients who had 35 iodized-oil defect areas (IODAs) in HCCs treated with TACE were included in our study. These patients were divided into two groups, one group with viable tumors (n = 22) and the other group with non-viable tumors (n = 13) in the IODA. All patients were followed up using triple-phase dynamic CT after the treatment. We compared (a) manual analysis, (b) using PRM results, and (c) using PRM results with automatic classifier to distinguish between two tumor groups based on dynamic CT images from two longitudinal exams. Two radiologists performed the manual analysis. The PRM approach was implemented using prototype software. We adopted an off-the-shelf k nearest neighbor (kNN) classifier and leave-one-out cross-validation for the third approach. The area under the curve (AUC) values were compared for three approaches. RESULTS Manual analysis yielded AUC of 0.74, using PRM results yielded AUC of 0.84, and using PRM results with an automatic classifier yielded AUC of 0.87. CONCLUSIONS We improved upon the standard manual analysis approach by adopting a novel image analysis method of PRM combined with an automatic classifier.
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Affiliation(s)
- Seung Joon Choi
- Department of Radiology, Gachon University Gil Hospital, Incheon, Korea
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Yeh ML, Huang CI, Huang CF, Hsieh MY, Huang JF, Dai CY, Lin ZY, Chen SC, Yu ML, Chuang WL. Neoadjuvant transcatheter arterial chemoembolization does not provide survival benefit compared to curative therapy alone in single hepatocellular carcinoma. Kaohsiung J Med Sci 2014; 31:77-82. [PMID: 25645985 DOI: 10.1016/j.kjms.2014.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 10/20/2014] [Accepted: 08/19/2014] [Indexed: 12/16/2022] Open
Abstract
The role of transcatheter arterial chemoembolization (TACE) prior to curative therapy is still unclear. The aim of our study was to elucidate the survival of single hepatocellular carcinoma (HCC) and also to clarify whether TACE plus sequential curative therapy provides benefits in single HCC. A total of 470 patients with a diagnosis of single HCC between 2005 and 2010 were studied. The factors associated with clinical outcomes were analyzed. The outcomes between patients who underwent neoadjuvant TACE and those who did not were also compared. The 1-, 3-, and 5-year overall survival (OS) rates of all patients were 92.6%, 73.3%, and 59.6%, respectively. Child-Pugh class A [HR: 2.04, 95% confidence interval (CI): 1.277-3.254, p = 0.003], very early stage Barcelona Clinic Liver Cancer (BCLC) (HR: 2.03, 95% CI: 1.021-4.025, p = 0.043), tumor size < 5 cm (HR: 1.75, 95% CI: 1.115-2.751, p = 0.015), alpha fetoprotein (AFP) level < 200 ng/mL (HR: 2.07, 95% CI: 1.346-3.182, p = 0.001), and curative-based therapy (HR: 2.16, 95% CI: 1.442-3.224, p < 0.001) were factors associated with better OS. The 1-, 3-, and 5-year disease-free survival (DFS) rates of all the patients were 75.4%, 53.7%, and 36.3%, respectively. Only Child-Pugh class A (HR: 1.57, 95% CI: 1.068-2.294, p = 0.022) and curative-based therapy (HR: 1.51, 95% CI: 1.128-2.028, p = 0.006) were significantly associated with better DFS. Neoadjuvant TACE did not provide benefit compared with curative therapy alone in subgroup analysis. In conclusion, neoadjuvant TACE is not recommended in single HCC patients who may indicate for curative therapy.
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Affiliation(s)
- Ming-Lun Yeh
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-I Huang
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Feng Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Yen Hsieh
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jee-Fu Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Yen Dai
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Zu-Yau Lin
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shinn-Cherng Chen
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Ming-Lung Yu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wan-Long Chuang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Cai H, Kong W, Zhou T, Qiu Y. Radiofrequency ablation versus reresection in treating recurrent hepatocellular carcinoma: a meta-analysis. Medicine (Baltimore) 2014; 93:e122. [PMID: 25396332 PMCID: PMC4616312 DOI: 10.1097/md.0000000000000122] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Treatment for recurrent hepatocellular carcinoma (RHCC) remains controversial. This study tried to compare survival benefits between radiofrequency ablation (RFA) and reresection for RHCC patients following curative surgical treatments.Databases were searched for comparative studies published from 2008 to 2014 on RFA versus reresection in treating RHCC. Meta-analysis was performed using a random or fixed-effect model to compare the overall survivals (OSs) and disease-free survivals (DFSs) between RFA and reresection. Begg funnel plot and Egger test were performed to assess the publication bias.Six retrospective comparative studies fulfilled our criteria and were included. For patients with RHCC, RFA was equivalent to reresection in 1-year OSs (odds ratio [OR] 0.86; 95% confidence interval [CI], 0.50-1.49; P = 0.587), 3-year OSs (OR 0.91; 95% CI, 0.64-1.28; P = 0.581), and 5-year OSs (OR 0.97; 95% CI, 0.69-1.36; P = 0.846). However, reresection was superior to RFA in 3-year DFSs (OR 2.25; 95% CI, 1.37-3.68; P = 0.001) and 5-year DFSs (OR 3.70; 95% CI, 1.98-6.93; P = 0.000). The outcome of 1-year DFSs was unstable with statistical heterogeneity among studies included in meta-analysis (I = 77.4%). No evidence of publication bias was found. RFA was considered as a less invasive modality for RHCC patients.RFA achieves comparable OSs as reresection in the treatment of RHCC, with lower postoperative complications.
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Affiliation(s)
- Hao Cai
- Liver Cancer Institute and Zhongshan Hospital (HC); Department of Ultrasound (WK), Zhongshan Hospital, Fudan University, Shanghai; and Department of Hepatobiliary Surgery (TZ, YQ), Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
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Abstract
Over the last decade, transarterial therapies have gained worldwide acceptance as standard of care for inoperable primary liver cancer. Survival times after transarterial chemoembolization (TACE) continue to improve as the technique and selection criteria are refined. Transarterial treatments, frequently provided in an outpatient setting, are now safely and effectively being applied to patients with even advanced malignancy or partially decompensated cirrhosis. In the coming years, newer transarterial therapies such as radiation segmentectomy, boosted-transarterial radioembolzation, combined TACE-ablation, TACE-portal vein embolization, and transarterial infusion of cancer-specific metabolic inhibitors promise to continue improving survival and quality of life.
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