1. Transarterial chemoembolization (TACE) was shown to have survival and treatment response rates comparable to both hepatic resection (HR) and radiofrequency ablation (RFA) in the management of small, focal hepatocellular carcinomas (HCC).
2. TACE was shown to be associated with a higher HCC recurrence rate relative to HR and RFA.
Evidence Rating Level: 2 (Good)
Study Rundown: Hepatocellular carcinoma (HCC) is among the leading cancer-related causes of death worldwide. The current standard-of-care for management of small HCCs involves a tiered approach, with hepatic resection (HR) favored over radiofrequency ablation (RFA) and other treatment modalities. Transarterial chemoembolization (TACE), a minimally-invasive procedure in which chemotherapeutic agents are administered directly to tumors by small arterial catheters alongside agents that interrupt tumor blood supply, is currently widely utilized for management of large and multifocal HCC. However its role in the management of small HCC has not been rigorously examined. The current study compared TACE to standard treatments (HR and RFA) among patients with small, focal HCC. Results suggested comparable five-year survival and overall treatment response rates between the three modalities, though treatment with TACE was noted to be an independent predictor of tumor recurrence. The primary limitations of the study were its retrospective design and sample size; further work is necessary to prospectively replicate these findings in a larger patient population.
In-Depth [retrospective cohort]: This study included 197 patients (52 HR, 79 RFA, 66 TACE) with small, single-nodule HCC without evidence of vascular invasion. Exclusion criteria included tumors >3 cm in size, Child-Pugh class C liver function, serious contemporaneous medical issues, and receipt of multimodality treatment. Patients were assigned to treatment groups according to current HCC treatment guidelines. HR was initially recommended as first-line therapy; among those with contraindications to HR, RFA was then recommended, followed by TACE. The study’s primary endpoint was overall survival; secondary endpoints included complete treatment response, adverse events, and tumor recurrence.
To control for the effects of selection bias, data were evaluated using inverse probability weighting (IPW). Using this technique, cumulative five-year overall survival did not vary significantly by treatment modality (HR 85.6%, RFA 87.6%, TACE 80.7%; P = 0.834). Multivariate analysis, with correction for independent predictors of overall survival, yielded a non-significant hazard ratio for TACE versus RFA and a non-significant hazard ratio for TACE versus. Adverse event rates were significantly higher in the HR group than in both the RFA and TACE groups. Finally, despite the correction of between-group differences using IPW, TACE was shown to be an independent predictor of tumor recurrence (P < 0.001).
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