Thermal ablation combined with transarterial chemoembolization for hepatocellular carcinoma: What is the right treatment sequence?
European Journal of Radiology, vol. 144, pp. 110006
Abstract
BACKGROUND: The combination treatment regimen of thermal ablation (TA) and transarterial chemoembolization (TACE) has gained a place in treatment of hepatocellular carcinoma (HCC) lesions > 3 cm unsuitable for surgery. Despite a high heterogeneity in the currently used treatment protocols, the pooled results of combined treatments seem to outperform those of TA or TACE alone. TACE preceding TA has been studied extensively, while results of the reverse treatment sequence are lacking. In this retrospective cohort study we compared the two treatment sequences. PATIENTS AND METHODS: 38 patients (median age: 68.5 yrs (range 40-84), male: 34, liver cirrhosis: 33, early stage HCC: 21, intermediate stage HCC: 17) were included in two tertiary referral centers, of whom 27 were treated with TA and adjuvant TACE (TA + TACE). The other 11 patients received TA with neoadjuvant TACE (TACE + TA). Overall survival (OS), time to progression (TTP) and local tumor progression (LTP) free survival were determined for the entire cohort and compared between the two treatment sequences. RESULTS: The median OS of all patients was 52.7 months and the median time to LTP was 11.5 months (censored for liver transplantation). No differences were found with respect to OS between the two treatment sequences. Median time to LTP for TACE + TA was 23.6 months and 8.1 months for TA + TACE (p = 0.19). DISCUSSION: No statistical differences were found for OS, TTP and time to LTP between patients treated with TA combined with neoadjuvant or adjuvant TACE.
Authors 10
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Leiden University Medical Center
Affiliation as printed
Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: p.hendriks@lumc.nl
Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
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Affiliation as printed
Department of Radiology, NWZ Hospital Group, Alkmaar, the Netherlands
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Leiden University Medical Center
Affiliation as printed
Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
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Leiden University Medical Center
Affiliation as printed
Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
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Leiden University Medical Center
Affiliation as printed
Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
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Amsterdam University Medical Centers
Affiliation as printed
Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, the Netherlands
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Leiden University Medical Center
Affiliation as printed
Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
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Leiden University Medical Center · University of Twente
Affiliation as printed
Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands; Biomedical Photonic Imaging Group, University of Twente, the Netherlands
Biomedical Photonic Imaging Group, University of Twente, the Netherlands
Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
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Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers
Affiliation as printed
Department of Radiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
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Leiden University Medical Center
Affiliation as printed
Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
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