Radiofrequency ablation combined with transcatheter arterial chemoembolization for the treatment of single hepatocellular carcinoma of 2 to 5 cm in diameter: comparison with surgical resection

Abstract

Objective: To compare the effectiveness of radiofrequency ablation (RFA) combined with transcatheter arterial chemoembolization (TACE) with surgical resection in patients with a single hepatocellular carcinoma (HCC) ranging from 2 to 5 cm.

Materials and methods: The study participants were enrolled over a period of 29 months and were comprised of 37 patients in a combined therapy group and 47 patients in a surgical resection group. RFA was performed the day after TACE, and surgical resection was performed by open laparotomy. The two groups were compared with respect to the length of hospital stay, rates of major complication, and rates of recurrence-free and overall survival.

Results: Major complications occurred more frequently in the surgical resection group (14.9%) than in the combined therapy group (2.7%). However, there was no statistical significance (p = 0.059). The rates of recurrence-free survival at 1, 2, 3 and 4 years were similar between the combined therapy group (89.2%, 75.2%, 69.4% and 69.4%, respectively) and the surgical resection group (81.8%, 68.5%, 68.5% and 65%, respectively) (p = 0.7962, log-rank test). The overall survival rates at 1, 2, 3 and 4 years were also similar between groups (97.3%, 86.5%, 78.4% and 78.4%, respectively, in the combined therapy group, and 95.7%, 89.4%, 84.3% and 80.3%, respectively, in the surgical resection group) (p = 0.6321, log-rank test).

Conclusion: When compared with surgical resection for the treatment of a single HCC ranging from 2 to 5 cm, RFA combined with TACE shows similar results in terms of recurrence-free and overall survival rates.

Keywords: Combination therapy; Hepatectomy; Hepatocellular carcinoma; Radiofrequency ablation; Transcatheter arterial chemoembolization.

Fig. 1

Images of 59-year-old man with 5 cm non-infiltrating HCC, who underwent combined TACE and RFA. A. Fat-suppressed T2-weighted axial MR image obtained 1 week before combined treatment of TACE and RFA shows 5 cm heterogeneous hyperintense mass (arrowheads) in right hepatic lobe. B. Post-TACE angiogram shows dense radiopaque mass (arrows) with accumulated iodized oil in right hepatic lobe. C. US image during RFA shows mass surrounded by transient hyperechoic zone (arrowheads) and echogenic RF electrode (arrow) within mass. D. Contrast-enhanced CT image obtained 24 months after combined therapy shows dense iodized oil accumulation in mass (asterisk) surrounded by RF-induced coagulation (arrowheads), without local tumor progression. HCC = hepatocellular carcinoma, TACE = transcatheter arterial chemoembolization, RFA = radiofrequency ablation, US = ultrasonography

Fig. 2

Graph illustrates recurrence-free survival rates in patients with single hepatocellular carcinoma ranging from 2 to 5 cm treated with combined therapy or surgical resection. There was no significant difference between two groups (p = 0.7962, log-rank test).

Fig. 3

Graph shows overall survival rates in patients with single hepatocellular carcinoma ranging from 2 to 5 cm treated with combined therapy or surgical resection. No significant difference was seen between two groups (p = 0.6321, log-rank test).