The online version of this article (doi:10.1186/1471-230X-14-11) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
LZ did literature search and wrote the paper; XY and XYX followed the patients; YHG, BHZ, YC, NLG, YHW and S LY carried out the TACE and RFA treatment; JBZ carried out the data analysis; ZGR revised the manuscript. All authors read and approved the final manuscript.
Recent studies suggest that a combination of radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) may have theoretical advantages over TACE alone for treatment of hepatocellular carcinoma (HCC). The purpose of this study was to evaluate the effectiveness and safety of radiofrequency ablation following first-line TACE treatment in the management of HCC beyond the Milan Criteria.
Forty-five patients who consecutively underwent RFA following first-line TACE treatment for HCC beyond the Milan criteria were enrolled in this study. RFA was performed within 1–2 months after TACE treatment in patients who had incomplete necrotic tumor nodules. Primary effectiveness, complications, survival rates, and prognostic factors were evaluated retrospectively.
Complete ablation was achieved in 76.2% of the lesions according to 1-month follow-up computed tomography/magnetic resonance imaging evaluation. The mean follow-up period was 30.9 months (range 3–94 months). There were no major complications after RFA therapy. The median overall survival was 29 months (range 20–38 months), with 1-, 2-, and 3-year survival of 89%, 61%, and 43%, respectively. Multivariate analysis revealed that tumor diameter (P = 0.045, hazard ratio [HR] = 0.228, 95% confidence interval [CI]: 0.054-0.968) and pretreatment serum alpha-fetoprotein level (P = 0.024, HR = 2.239, 95% CI: 1.114-4.500) were independent predictors for long-term survival.
HCC beyond the Milan criteria can be completely and safely ablated by radiofrequency ablation following first-line TACE treatment with a low rate of complications and favorable survival outcome. Further assessment of the survival benefits of combination treatment for HCCs beyond the Milan Criteria is warranted.
Llovet JM, Real MI, Montana X, Planas R, Coll S, Aponte J, Ayuso C, Sala M, Muchart J, Sola R, Rodes J, Bruix J: Arterial embolisation or chemoembolisation versus symptomatic treatment in patient with unresectable hepatocellular carcinoma: a randomized controlled trial. Lancet. 2002, 359: 1734-1739. 10.1016/S0140-6736(02)08649-X. CrossRefPubMed
McGahan JF, Dodd GD: Radiofrequency ablation of the liver: current status. Am J Roentgenol. 2001, 176: 3-16. 10.2214/ajr.176.1.1760003. CrossRef
Lencioni R, Allgaier HP, Cioni D, Olschewski M, Deibert P, Crocetti L, Fring H, Laubenberger J, Zuber I, Blum HE, Bartolozzi C: Small hepatocellular carcinoma in cirrhosis: randomized comparison of radio-frequency thermal ablation versus percutaneous ethanol injection. Radiology. 2003, 228: 235-240. 10.1148/radiol.2281020718. CrossRefPubMed
Hsu CY, Huang YH, Chiou YY, Su CW, Lin HC, Lee RC, Chiang JH, Huo TI, Lee FY, Lee SD: Comparison of radiofrequency ablation and transarterial chemoembolization for hepatocellular carcinoma within the Milan Criteria: A propensity score analysis. Liver Transpl. 2011, 17: 556-566. 10.1002/lt.22273. CrossRefPubMed
Peng ZW, Chen MS, Liang HH, Gao HJ, Zhang YJ, Li JQ, Zhang YQ, Lau WY: A case–control study comparing percutaneous radiofrequency ablation alone or combined with transcatheter arterial chemoembolization for hepatocellular carcinoma. Eur J Surg Oncol. 2010, 36: 257-263. 10.1016/j.ejso.2009.07.007. CrossRefPubMed
Kirikoshi H, Saito S, Yoneda M, Fujita K, Mawatari H, Uchiyama T, Higurashi T, Goto A, Takahashi H, Abe Y, Inamori M, Kobayashi N, Kubota K, Sakaguchi T, Ueno N, Nakajima A: Outcome of transarterial chemoembolization monotherapy, and in combination with percutaneous ethanol injection, or radiofrequency ablation therapy for hepatocellular carcinoma. Hepatol Res. 2009, 39: 553-562. 10.1111/j.1872-034X.2009.00490.x. CrossRefPubMed
Yang B, Zou J, Xia J, Ren Z, Gan Y, Wang Y, Zhang B, Ge N, Wang D, Chen Y, Chen R, Li L, Ye S, Wang X: Risk factors for recurrence of small hepatocellular carcinoma after long-term follow-up of precutaneous radiofrequency ablation. Eur J Radiol. 2011, 79: 196-200. 10.1016/j.ejrad.2010.02.010. CrossRefPubMed
Yamasaki T, Kurokawa F, Shirahashi H, Kusano N, Hironaka K, Okita K: Percutaneous radiofrequency ablation therapy for patients with hepatocellular carcinoma during occlusion of hepatic blood flow. Comparison with standard percutaneous radiofrequency ablation therapy. Cancer. 2002, 95: 2353-2360. 10.1002/cncr.10966. CrossRefPubMed
Rossi S, Garbagnati F, De Francesco I, Accocella F, Leonardi L, Quaretti P, Zangrandi A, Paties C, Lencioni R: Relationship between the shape and size of radiofrequency-induced thermal lesions and hepatic vascularization. Tumori. 1999, 85: 128-132. PubMed
Lencioni R, Cioni D, Donati F, Bartolozzi C: Combination of interventional therapies in hepatocellular carcinoma. Hepatogastroenterology. 2001, 48: 8-14. PubMed
Veltri A, Moretto P, Doriguzzi A, Pagano E, Carrara G, Gandini G: Radiofrequency thermal ablation (RFA) after transarterial chemoembolization (TACE) as a combined therapy for unresectable non-early hepatocellular carcinoma (HCC). Eur Radiol. 2006, 16: 661-669. 10.1007/s00330-005-0029-9. CrossRefPubMed
- Radiofrequency ablation following first-line transarterial chemoembolization for patients with unresectable hepatocellular carcinoma beyond the Milan criteria
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