Laser ablation is superior to TACE in large-sized hepatocellular carcinoma: a pilot case–control study
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Filomena Morisco1, Silvia Camera1, Maria Guarino1, Raffaella Tortora2, Valentina Cossiga1, Anna Vitiello1, Gabriella Cordone2, Nicola Caporaso1, Giovan Giuseppe Di Costanzo2 and Italian Liver Cancer (ITA.LI.CA) group
1Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
2Hepatology Unit, “Cardarelli” Hospital, Naples, Italy
Filomena Morisco, email: [email protected]
Keywords: large HCC; laser ablation; TACE
Received: December 13, 2017 Accepted: February 27, 2018 Published: April 03, 2018
Background:Limited therapies are available for large (≥40 mm) unresectable hepatocellular carcinoma (HCC). Currently, the standard treatment with transarterial chemoembolisation (TACE) is unsatisfactory with high recurrence rate and limited effect on survival. Laser Ablation (LA) has emerged as a relatively new technique characterized by high efficacy and good safety. This study is aimed to evaluate the efficacy of LA in comparison to TACE in patients with large HCC.
Methods: Eighty-two patients with a single HCC nodule ≥40 mm (BCLC stage A or B) were enrolled in this case-control study. Forty-one patients were treated with LA and 41 patients were treated with TACE. Response to therapy was evaluated according to the mRECIST criteria. Survival was calculated with Kaplan-Meier from the time of cancer diagnosis to death with values censored at the date of the last follow-up.
Results: Twenty-six (63.4%) and 8 (19.5%) patients had a complete response after LA and TACE, respectively (p < 0.001). Subsequently we stratified the HCCs in 3 categories according to the nodule size: 40–50 mm, 51–60 mm, and >60 mm. LA resulted superior to TACE especially in nodules ranging between 51 and 60 mm in diameter, with a complete response rate post-LA and post-TACE of 75% and 14.3%, respectively (p = 0.0133). The 36 months cumulative survival rate in patients treated with LA and TACE was 55.4% and 48.8%, respectively. The disease recurrence rates after LA and TACE were 19.5% and 75.0%, respectively.
Conclusions: LA is a more effective therapeutic option than TACE in patients with solitary large HCC.
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