title: Multimodality treatment with conventional transcatheter arterial chemoembolization and radiofrequency ablation for unresectable hepatocellular carcinoma.
abstract: OBJECTIVE
  To evaluate the efficacy of multimodality treatment consisting of conventional transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA) in patients with non-resectable and non-ablatable hepatocellular carcinoma (HCC).
  
  
  METHODS
  In this retrospective study, 85 consecutive patients with HCC (59 solitary, 29 multifocal HCC) received TACE followed by RFA between 2001 and 2010. The mean number of tumors per patient was 1.6 ± 0.7 with a mean size of 3.0 ± 0.9 cm. Both local efficacy and patient survival were evaluated.
  
  
  RESULTS
  Of 120 treated HCCs, 99 (82.5%) showed a complete response (CR), while in 21 HCCs (17.5%) a partial response was depicted. Patients with solitary HCC revealed CR in 91% (51/56); in patients with multifocal HCC (n = 29) CR was achieved in 75% (48 of 64 HCCs). The median survival for all patients was 25.5 months. The 1-, 2-, 3- and 5-year survival rates were 84.6, 58.7, 37.6 and 14.6%, respectively. Statistical analysis revealed a significant difference in survival between Barcelona Clinic Liver Cancer (BCLC) A (73.4 months) and B (50.3 months) patients, while analyses failed to show a difference for Child-Pugh score, Cancer of Liver Italian Program (CLIP) score and tumor distribution pattern.
  
  
  CONCLUSIONS
  TACE combined with RFA provides an effective treatment approach with high local tumor control rates and promising survival data, especially for BCLC A patients. Randomized trials are needed to compare this multimodality approach with a single modality approach for early-stage HCC.
authors.affiliation: Department of Radiology, Ludwig Maximilians University of Munich, Campus Grosshadern, Munich, Germany. nima.ashoori@med.uni-muenchen.de
authors.forename: N
authors.initials: N
authors.lastname: Ashoori
authors.forename: P
authors.initials: P
authors.lastname: Paprottka
authors.forename: C
authors.initials: C
authors.lastname: Trumm
authors.forename: F
authors.initials: F
authors.lastname: Bamberg
authors.forename: F T
authors.initials: FT
authors.lastname: Kolligs
authors.forename: M
authors.initials: M
authors.lastname: Rentsch
authors.forename: M F
authors.initials: MF
authors.lastname: Reiser
authors.forename: T F
authors.initials: TF
authors.lastname: Jakobs
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000628:therapy*; D017115:Catheter Ablation; D016461:Chemoembolization, Therapeutic; D003131:Combined Modality Therapy; D005260:Female; D005858:Germany; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome