Midterm Outcomes in Patients With Intermediate-Sized Hepatocellular Carcinoma

BACKGROUND: To improve the efficacy of radiofrequency ablation (RFA) for the treatment of intermediate-sized hepatocellular carcinomas (HCCs), the authors compared PEA combined with transcatheter arterial chemoembolization (TACE) to RFA alone. METHODS: The authors randomly assigned 37 patients with solitary HCCs (diameter, 3.1-5.0 cm in the greatest dimension) to 2 groups: the TACE-RFA group, in which the patients received TACE followed by RFA on the same day, and the RFA group, in which the patients received only PEA. RESULTS: Technical success was achieved after 1.4 +/- 0.5 RFA sessions in the RFA group and after 1.1 +/- 0.2 RFA sessions in the TACE-RFA group (P < .01). The mean diameters of the longer and shorter axes of the RFA-induced ablated areas were 50 +/- 8.0 mm and 41 +/- 7.1 mm, respectively, in the RFA group and 58 +/- 13.2 mm and 50 +/- 11.3 mm, respectively, in the TACE-RFA group; the mean diameters of the shorter axes were significantly different (P = .012). The rates of local tumor progression at the end of the third year in the RFA and TACE-RFA groups were 39% and 6%, respectively (P = .012). The 3-year survival rates of the patients in the RFA and TACE-RFA groups were 80% and 93%, respectively (P = .369). CONCLUSIONS: In patients with intermediate-sized HCCs, RFA combined with TACE is more effective than RFA alone for extending the ablated area in fewer treatment sessions and for decreasing the local tumor progression rate. Cancer 2010;116:5452-60 (C) 2010 American Cancer Society.