Radiofrequency ablation following first-line transarterial chemoembolization for patients with unresectable hepatocellular carcinoma beyond the Milan criteria

Lan Zhang, Xin Yin, Yu-Hong Gan, Bo-Heng Zhang, Ju-Bo Zhang, Yi Chen, Xiao-Ying Xie, Ning-Lin Ge, Yan-Hong Wang, Sheng-Long Ye, Zheng-Gang Ren, Lan Zhang, Xin Yin, Yu-Hong Gan, Bo-Heng Zhang, Ju-Bo Zhang, Yi Chen, Xiao-Ying Xie, Ning-Lin Ge, Yan-Hong Wang, Sheng-Long Ye, Zheng-Gang Ren

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Figures

Figure 1
Figure 1
Complete ablation of HCC. A: MRI image before TACE; B: CT image before RFA; C: MRI image after RFA.
Figure 2
Figure 2
Incomplete ablation of HCC. A: CT image before RFA; B and C: MRI image after RFA.
Figure 3
Figure 3
Survival curves of patients treated with RFA after first-line treatment with TACE. A: Overall cumulative survival of 45 patients treated with RFA after first-line treatment with TACE; B: Cumulative survival according to AFP level; C: Cumulative survival according to tumor size.

References

    1. Ding SJ, Li Y, Tan YX, Jiang MR, Tian B, Liu YK, Shao XX, Ye SL, Wu JR, Zeng R, Wang HY, Tang ZY, Xia QC. From proteomic analysis to clinical significance: overexpression of cytokeratin 19 correlates with hepatocellular carcinoma metastasis. Mol Cell Proteomics. 2004;3:73–81.
    1. Altekruse SF, McGlynn KA, Reichman ME. Hepatocellular carcinoma incidence, mortality, and survival trends in the United States from 1975 to 2005. J Clin Oncol. 2009;27:1485–1491. doi: 10.1200/JCO.2008.20.7753.
    1. Sangiovanni A, Del Ninno E, Fasani P, De F, Ronchi G, Romeo R, Morabito A, De Franchis R, Colombo M. Increased survival of cirrhotic patients with a hepatocellular carcinoma detected during surveillance. Gastroenterology. 2004;126:1005–1014. doi: 10.1053/j.gastro.2003.12.049.
    1. 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. doi: 10.1016/S0140-6736(02)08649-X.
    1. Lo CM, Nqan H, Tso WK, Liu CL, Lam CM, Poon RT, Fan ST, Wong J. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology. 2002;35:1164–1167. doi: 10.1053/jhep.2002.33156.
    1. Llovet JM, Bruix J. Systematic review of randomize trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival. Hepatology. 2003;37:429–442. doi: 10.1053/jhep.2003.50047.
    1. Jansen MC, van Hillegersberg R, Chamuleau RA, van Delden OM, Gouma DJ, van Guilk TM. Outcome of regional and local ablative therapies for hepatocellular carcinoma: a collective review. Eur J Surg Oncol. 2005;31:331–347. doi: 10.1016/j.ejso.2004.10.011.
    1. McGahan JF, Dodd GD. Radiofrequency ablation of the liver: current status. Am J Roentgenol. 2001;176:3–16. doi: 10.2214/ajr.176.1.1760003.
    1. 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. doi: 10.1148/radiol.2281020718.
    1. Buscarini L, Buscarini E, Di Stasi M, Vallisa D, Quaretti P, Rocca A. Percutaneous radiofrequency ablation of small hepatocellular carcinoma: long term results. Eur Radiol. 2001;11:914–921. doi: 10.1007/s003300000659.
    1. Livraghi T, Goldberg SN, Lazzaroni S, Meloni F, Ierace T, Solbiati L, Gazelle GS. Hepatocellular carcinoma: radio-frequency ablation of medium and large lesions. Radiology. 2000;214:761–768. doi: 10.1148/radiology.214.3.r00mr02761.
    1. Dupuy DE, Goldberg SN. Image-guided radiofrequency tumor ablation: challenges and opportunities–part II. J Vasc Interv Radiol. 2001;12:1135–1148. doi: 10.1016/S1051-0443(07)61670-4.
    1. Curley SA. Radiofrequency ablation of malignant liver tumors. Ann Surg Oncol. 2003;10:338–347. doi: 10.1245/ASO.2003.07.017.
    1. 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. doi: 10.1002/lt.22273.
    1. 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. doi: 10.1016/j.ejso.2009.07.007.
    1. Takaki H, Yamakado K, Uraki J, Nakatsuka A, Fuke H, Yamamoto N, Shiraki K, Yamada T, Takeda K. Radiofrequency ablation combined with chemoembolization for the treatment of hepatocellular carcinomas larger than 5 cm. J Vasc Interv Radiol. 2009;20:217–224. doi: 10.1016/j.jvir.2008.10.019.
    1. 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. doi: 10.1111/j.1872-034X.2009.00490.x.
    1. Bruix J, Sherman M. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53:1020–1022. doi: 10.1002/hep.24199.
    1. 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. doi: 10.1016/j.ejrad.2010.02.010.
    1. Lau WY, Leung TW, Yu SC, Ho SK. Percutaneous local ablative therapy for hepatocellular carcinoma: a review and look into the future. Ann Surg. 2003;237:171–179.
    1. de Baere T, Elias D, Dromain C, Din MG, Kuoch V, Ducreux M, Boige V, Lassau N, Marteau V, Lasser P, Roche A. Radiofrequency ablation of 100 hepatic metastases with a mean follow-up of more than 1 year. AJR Am J Roentgenol. 2000;175:1619–1625. doi: 10.2214/ajr.175.6.1751619.
    1. 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. doi: 10.1002/cncr.10966.
    1. 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.
    1. Buscarini L, Buscarini E, Di Stasi M, Quaretti P, Zangrandi A. Percutaneous radiofrequency thermal ablation combined with transcatheter arterial embolization in the treatment of large hepatocellular carcinoma. Ultraschall Med. 1999;20:47–53. doi: 10.1055/s-1999-14233.
    1. Lencioni R, Cioni D, Donati F, Bartolozzi C. Combination of interventional therapies in hepatocellular carcinoma. Hepatogastroenterology. 2001;48:8–14.
    1. Vogl TJ, Mack MG, Balzer JO, Engelmann K, Straub R, Eichler K, Woitaschek D, Zangos S. Liver metastases: neoadjuvant downsizing with trans-arterial chemoembolization before laser-induced thermotheraphy. Radiology. 2003;229:457–464. doi: 10.1148/radiol.2292021329.
    1. 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. doi: 10.1007/s00330-005-0029-9.
    1. Liao GS, Yu CY, Shih ML, Chan DC, Liu YC, Yu JC, Chen TW, Hsieh CB. Radiofrequency ablation after transarterial embolization as therapy for patients with unresectable hepatocellular carcinoma. Eur J Surg Oncol. 2008;34:61–66. doi: 10.1016/j.ejso.2007.02.006.
    1. Stuart KE, Anand AJ, Jennins RL. Hepatocellular carcinoma in the United States. Cancer. 1996;77:2217–2222. doi: 10.1002/(SICI)1097-0142(19960601)77:11<2217::AID-CNCR6>;2-M.
    1. Mondazzi L, Bottelli R, Brambilla G, Rampoldi A, Rezakovic I, Zavaglia C, Alberti A, Ideo G. Transarterial oily chemoembolization for the treatment of hepatocellular carcinoma:A multivariate analysis of prognostic factors. Hepatology. 1994;19:1115–1123. doi: 10.1002/hep.1840190508.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere