Aim: to compare efficacy of combined transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) versus TACE alone in pre transplant treatment of hepatocellular carcinoma (HCC) based on pathologic assessment of the explanted livers.
Methods: Between April 2008 and April 2012, 68 consecutive HCC patients were treated either with combined TACE and RFA or TACE alone. The two groups were compared in terms of demographics, tumor characteristics, explant pathology and survival. Tumor necrosis was graded based on the percentage of necrotic cells in the tumor.
16 patients received combined therapy and 52 patients received TACE only. Median follow up was 22.8 months. TACE alone resulted in complete tumor necrosis in 12%, more 50% necrosis in 48% of patients, less than 50% necrosis in 19% of patients, and no response in 21% of patients. In comparison, combined TACE and RFA resulted in complete necrosis in 38% and more than 50% necrosis in 62% of patients (p=0.009). Tumor characteristics and survival are summarized in the following table:
|Tumor characteristics & survival||Combined TACE & RFA||TACE only||P-value|
|Vascular invasion||2/16 (12.5%)||3/52 (6%)||NS|
|Multifocal disease||9/16 (56%)||31/52 (60%)||NS|
|Outside UCSF criteria||9/16 (56%)||14/52 (27%)||0.03|
|Tumor recurrence||2/16 (12.5%)||3/52 (6%)||NS|
|1-year patient survival||94%||98%||0.34*|
|3-year patients survival||94%||85%||0.57*|
Combined TACE and RFA appears to be more effective in inducing HCC necrosis than TACE alone especially in tumors outside UCSF criteria. This has no significant impact on 1- and 3- years tumor recurrence and patient survival.
To cite this abstract in AMA style:Boktour M, Asham E, Frenette C, Monsour H, Galati J, Heyne K, Weiner M, Gaber A, Ghobrial R. Pre Liver Transplant Loco Regional Bridging Therapy for HCC: Efficacy of Combined TACE and RFA Versus TACE Alone Based on Explant Pathology [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/pre-liver-transplant-loco-regional-bridging-therapy-for-hcc-efficacy-of-combined-tace-and-rfa-versus-tace-alone-based-on-explant-pathology/. Accessed January 23, 2020.
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