Oncotarget

Clinical Research Papers:

Transarterial chemoembolization for early stage hepatocellular carcinoma decrease local tumor control and overall survival compared to radiofrequency ablation

Arnaud Hocquelet _, Olivier Seror, Jean-Frédéric Blanc, Nora Frulio, Cécile Salut, Jean-Charles Nault and Hervé Trillaud

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Oncotarget. 2017; 8:32190-32200. https://doi.org/10.18632/oncotarget.12921

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Abstract

Arnaud Hocquelet1,2, Olivier Seror3, Jean-Frédéric Blanc4, Nora Frulio1, Cécile Salut1, Jean-Charles Nault5 and Hervé Trillaud1,2

1 Department of Diagnostic and Interventional Imaging, Hôpital Saint-André, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France

2 EA IMOTION (Imagerie Moléculaire et Thérapies Innovantes en Oncologie) Université de Bordeaux, Bordeaux, France

3 Department of Radiology, Hôpital Jean Verdier (Assistance Publique-Hôpitaux de Paris), Bondy, France

4 Department of HepatoGastroenterology and Digestive oncology, Hôpital Saint-André, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France

5 Inserm, Génomique Fonctionelle des Tumeurs Solides, Paris, France

Correspondence to:

Arnaud Hocquelet, email:

Keywords: chemoembolization, therapeutic, radiofrequency ablation, carcinoma, hepatocellular

Received: June 07, 2016 Accepted: October 21, 2016 Published: October 26, 2016

Abstract

Background & Aims: To compare treatment failure and survival associated with ultrasound-guided radiofrequency ablation (RFA) and trans-arterial chemoembolization (TACE) for early-stage HCC in Child-Pugh A cirrhosis patients.

Methods: 122 cirrhotic patients (RFA: 61; TACE: 61) were well matched according to cirrhosis severity; tumor size and serum alpha-fetoprotein. TACE was performed in case of inconspicuous nodule on US or nodule with “at risk location”. Treatment failure was defined as local tumor progression (LTP) and primary treatment failure (failing to obtain complete response after two treatment session). Treatment failure and overall survival (OS) were compared after coarsened exact matching. Cox proportional model to assess independent predictive factors was performed.

Results: No significant difference was seen for baseline characteristics between the two groups. Mean tumor size was 3cm in both group with 41% HCC>3cm. Treatment failure rates after TACE was 42.6% (14 primary treatment failures and 12 LTP) and 9.8% after RFA (no primary treatment failure and 6 LTP) P < 0.001. TACE was the only predictive factor of treatment failure (Hazard ratio: 5.573). The 4-years OS after RFA and TACE were 54.1% and 31.5% (P = 0.042), respectively.

Conclusion: For Child-Pugh A patients with early-stage HCC, alternative treatment as supra-selective TACE to RFA regarded as too challenging using common US guidance decrease significantly the local tumor control and overall survival. Efforts to improve feasibility of RFA especially for inconspicuous target have to be made.


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