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used: Student’s t-test, Wilcoxon rank sum test, Chi-square, Table 1: Scoring systems before treatment
and Kaplan-Meier. Variable n = 25 (n (%)) P
TACE RFA-TACE
RESULTS Child-Pugh class
A 23 (92.0) 24 (96.0) > 0.05
Both groups were matched with regards to age and sex. B 2 (8.0) 1 (4.0)
Comparison between both groups regarding the different Okuda stage
scoring systems shows no statistically significant difference I II 24 (96.0) 25 (100) > 0.05
0 (0)
1 (4.0)
(P > 0.05). There were 23 (92%) Child-Pugh class A and 2 (8%) PST
class B patients in the TACE only group vs. 24 (96%) and 0 18 (72.0) 14 (56.0) > 0.05
1 (4%) in the RFA-TACE group. Performance status grades 1 7 (28.0) 11 (44.0)
of 0 were present in 18 (72%) patients and 7 (28%) with BCLC
grade 0 in TACE vs. 14 (56%) and 11 (44%) in RFA-TACE. BCLC B 18 (72.0) 14 (56.0) > 0.05
stage B was found in 18 (72%) and 7 (28%) in stage C TACE C 7 (28.0) 11 (44.0)
RFA: radiofrequency ablation; TACE: trans-arterial chemoembolization;
vs. 14 (56%) and 11 (44%) in RFA-TACE respectively [Table 1]. PST: performance status test; BCLC: Barcelona-Clinic liver cancer
Table 2 shows the response to the treatment after 1 month,
with all patients underwent RFA-TACE achieved CR, but Table 2: Treatment response in the studied groups
with no statistically significant difference between both n = 25 (n (%)) P
groups (P > 0.05). After 7 months of treatment, the rate of TACE RFA-TACE
the objective response (which includes both CR and PR for After 1 month
at least 6 months) was higher in RFA-TACE than that of TACE Complete response 21 (84) 25 (100) > 0.05
2 (8)
alone (P < 0.01). It was noted that lesions of more than 5 cm Partial response 2 (8.0) 0 (0)
0 (0)
Progressive disease
were more liable to PR and PD after chemoembolization After 7 months
alone. Performance status was improved in the RFA-TACE Objective response 11 (44) 21 (84) < 0.01
groups, shifting from a grade of 1-0 (P < 0.01). As RFA: radiofrequency ablation; TACE: trans-arterial chemoembolization
summarized in Table 3, 1-year total recurrence rates and
local tumor progression rates were higher in patients Table 3: Overall recurrence rates at 13 months following
that underwent chemoembolization alone (P < 0.01). In the procedure
n = 25 (n (%)) P
Table 4, 1-year disease free survival rates and overall survival
TACE
rates were higher after the combined therapy (P < 0.001). Total recurrence of HCC 18 (72) RFA-TACE < 0.05
9 (36)
Figure 1 shows the median survival time for the two studied (same lesion and/or new lesion)
groups, which was 13 months with no statistically significant Recurrence of HCC in same lesion only 14 (56) 4 (16) < 0.01
difference (P > 0.05). Comparison between both groups RFA: radiofrequency ablation; TACE: trans-arterial chemoembolization;
HCC: hepatocellular carcinoma
with regards to survival rates at 7 months and at 1 year is
shown in Figure 2. No major complication was reported after Table 4: The disease free survival rate and the survival
combined therapy or after TACE only; only post-embolization rate in the studied groups
syndrome was reported as a minor complication in 68% n = 25 (n (%)) P
and 72% of the patients in RFA-TACE and TACE groups, TACE RFA-TACE
respectively. Disease free survival rate at 1 year 6 (24) 14 (56) <
0.001
DISCUSSION Overall survival rate at 1 year 20 (80) 22 (88) > 0.05
RFA: radiofrequency ablation; TACE: trans-arterial chemoembolization
Hepatocellular carcinoma is the fifth most common cancer for multinodular HCC, and for large HCCs in patients
[14]
worldwide and the third leading cause of cancer-related who are not surgical candidates. Another promising role
[15]
mortality, with its incidence increasing worldwide ranging of RFA is to be combined with TACE for the treatment of
[12]
between 3% and 9% annually. The European Association intermediate and large tumors, so as to obtain a large area
[16]
[13]
for the Study of Liver and the American Association for the of coagulation. The combination of TACE with RFA has two
[17]
Study of Liver Diseases recommends RFA as a non-surgical theoretical merits: (1) occlusion of hepatic arterial flow by
technique for the treatment of early stage HCC (Child-Pugh means of embolization may contribute to the decrease in
class A or B, solitary HCCs or up to 3 nodules with each the heat-sink effects during RFA and increase the ablation
≤ 3 cm in size). TACE has become the treatment of choice volume by RFA; and (2) combined treatment may have the
[7]

Hepatoma Research | Volume 1 | Issue 1 | April 15, 2015 21