A
proportion of individuals with chronic hepatitis
B or C virus infection may go on to develop
advanced liver disease, including hepatocellular
carcinoma (HCC). Unfortunately, HCC is a difficult form of cancer to treat
and the mortality rate is high, partly because it is usually detected at an advanced
stage.
In a study published in the April 9, 2008 Journal of the American
Medical Association, researchers from Qilu Hospital School of Medicine and
Shandong University in China compared the benefits of 2 treatment methods alone
or in combination:
•
Transarterial chemoembolization (TACE): a method in which the blood supply to
the hepatic artery serving the liver tumor is blocked and chemotherapy drugs are
directly administered;
•
Radiofrequency ablation (RFA): a method of destroying tumors with heat using a
high frequency current delivered through a needle electrode.
Both
methods have been used for patients with large HCC tumors, but the survival benefits
of combination treatment are not known, according to the study authors.
In
this randomized, controlled trial, conducted at a single center in Jinan, China
between January 2001 and May 2004, a total of 291 consecutive patients with HCC
tumors larger than 3 cm were assigned to undergo TACE only, RFA only, or both
procedures in combination. The primary endpoint was survival and the secondary
endpoint was objective response rate.
Results
•
During a median 28.5 months of follow-up, median survival times were 24 months
in the TACE only group (3.4 courses), 22 months in the RFA only group (3.6 courses),
and 37 months in the TACE + RFA group (4.4 courses).
•
Patients treated with TACE + RFA had better overall survival (31%) than those
treated with either TACE alone (16%; hazard ratio [HR] 1.87; P < .001) or RFA
alone (16%; HR 1.88; P < .001).
•
In a preplanned substratification analysis, survival was also better in the TACE
+ RFA group than in the RFA only group for patients with uninodular (single node)
carcinoma (HR 2.50; P = .001).
•
Survival was better in the TACE + RFA group than in the TACE only group for patients
with multinodular (multiple mode) carcinoma (HR 1.99; P < .001).
•
The rate of objective response sustained for at least 6 months was higher in the
TACE + RFA group (54%) compared with either the TACE only group (35%; rate difference
0.19; P = .009) or the RFA only group (36%; rate difference 0.18; P = .01).
Conclusion
Based on
these findings, the investigators concluded, "The current study demonstrates
that combination therapy with TACE and RFA was an effective and safe treatment
that may improve long-term survival for patients with hepatocellular carcinoma
larger than 3 cm."
In their discussion, the authors suggested that
the superior results may be attributable to the fact that blocking blood flow
to the tumor using TACE may allow for more prolonged heating and destruction of
the cancer using RFA.
4/11/08
References
B-Q Cheng,
C-Q Jia, C-T Liu, and others. Chemoembolization Combined With Radiofrequency Ablation
for Patients With Hepatocellular Carcinoma Larger Than 3 cm. Journal of the
American Medical Association 299(14): 1669-1677. April 9, 2008.
AX
Zhu and GK Abou-Alfa. Expanding the Treatment Options for Hepatocellular Carcinoma:
Combining Transarterial Chemoembolization With Radiofrequency Ablation. Journal
of the American Medical Association 299(14): 1716-1718. April 9, 2008.
FDA-approved
Treatments
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