Small hepatocellular carcinoma: is radiofrequency ablation combined with transcatheter arterial chemoembolization more effective than radiofrequency ablation alone for treatment?
OBJECTIVE
To prospectively compare combined radiofrequency ablation and transcatheter arterial chemoembolization (TACE) with radiofrequency ablation alone for the treatment of small (< or =3 cm) hepatocellular carcinomas (HCCs).


METHODS
The ethics committee of the study institution approved the study protocol. Written informed consent was obtained from all patients at enrollment. Eighty-nine patients with 93 HCC nodules 0.8-3.0 cm (mean +/- standard deviation, 1.7 cm +/- 0.5) in diameter were randomly treated with combined radiofrequency ablation and TACE (46 patients with 49 nodules) or with radiofrequency ablation alone (43 patients with 44 nodules). The patients were followed up for 9-68 months (mean +/- standard deviation, 30.4 months +/- 14.0). Rates of local tumor progression, overall survival, local progression-free survival, and event-free survival were evaluated by using the Kaplan-Meier method.


RESULTS
The 1-, 2-, 3-, and 4-year rates of local tumor progression, overall survival, local progression-free survival, and recurrence-free survival were as follows: Local tumor progression rates were 14.4%, 17.6%, 17.6%, and 17.6%, respectively, in the combined treatment group and 11.4%, 14.4%, 14.4%, and 14.4%, respectively, in the radiofrequency ablation group (P = .797). Overall survival rates were 100%, 100%, 84.8%, and 72.7%, respectively, in the combined treatment group and 100%, 88.8%, 84.5%, and 74.0%, respectively, in the radiofrequency ablation group (P = .515). Local progression-free survival rates were 84.6%, 81.1%, 69.7%, and 55.8%, respectively, in the combined treatment group and 88.4%, 74.1%, 74.1%, and 61.7%, respectively, in the radiofrequency ablation group (P = .934). Event-free survival rates were 71.3%, 59.9%, 48.8%, and 36.6%, respectively, in the combined treatment group and 74.3%, 52.4%, 29.7%, and 29.7%, respectively, in the radiofrequency ablation group (P = .365).


CONCLUSIONS
Combined radiofrequency ablation plus TACE and radiofrequency ablation alone have equivalent effectiveness for the treatment of small (< or =3 cm) HCCs, so the combination treatment may not be necessary.
Shibata
Toshiya
T
Department of Radiology, Kyoto University Graduate School of Medicine, 54-Kawaharacho, Shogoin, Sakyoku, Kyoto 606-8507, Japan. ksj@kuhp.kyto-u.ac.jp
Isoda
Hiroyoshi
H
Hirokawa
Yusuke
Y
Arizono
Shigeki
S
Shimada
Kotaro
K
Togashi
Kaori
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000601:surgery / Q000628:therapy*; D017115:Catheter Ablation / Q000379:methods*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D016009:Chi-Square Distribution; D018450:Disease Progression; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D015641:Radiography, Interventional; D018709:Statistics, Nonparametric; D015996:Survival Rate; D014057:Tomography, X-Ray Computed