Comparison

of Combina-on Therapies in the

Management of Hepatocellular Carcinoma:
Transarterial Chemoemboliza-on with
Radiofrequency Abla-on versus Microwave Abla-on
SIR-RFS Journal Primer

Quick Summary
BOTTOM LINE

Based on a retrospective study on 89 patients, transarterial chemoembolization with RF ablation

and transarterial chemoembolization with MW ablation are both effective treatments for
hepatocellular carcinoma.

MAJOR POINTS

Complete local tumor response was achieved in 80.4% of tumors treated with TACE + RFA and
76.6% treated with TACE + MWA

Median progression free survival was 9.3 mo with TACE + RFA and 9.2 mo for TACE + MWA

Median tumor progression free survival was 20.8 mo for TACE + RFA and 21.8 mo for TACE + MWA

CRITICISM

Small sample size: n = 89 at a single institution

Study was retrospective nature

Complexity of liver disease made multivariate analysis difVicult

Short follow-up period: TACE + MWA class had shorter follow up which may have limited the
accurate evaluation of long-term efVicacy

Study design
SINGLE CENTER RETROSPECTIVE REVIEW

89 patients with hepatocellular carcinoma treated with TACE + RFA (38) and
TACE + MWA (51) from November 1, 2003 November 1, 2011

INCLUSION CRITERIA

Ages 34-89

HCC diagnosed by presence of hypervascular liver mass > 1cm with arterial
uptake followed by washout of contrast in the venous-delayed phases on
either multiphase CT or MRI in accordance with AASLD

Disease burden was staged using Child-Pugh criteria, UNOS and BCLC
classiVications

EXCLUSION CRITERIA

Evidence of distant metastasis

Purpose
To retrospectively compare the outcomes and complications of transcatheter
transarterial chemoembolization with drug-eluting embolic agents combined with RFA vs
transcatheter transarterial chemoembolization with drug-eluting embolic agents
combined with MWA in the treatment of HCC

Interven7on: TACE + RFA and TACE + MWA

89 pa7ents

All subjects had HCC

Tumor Evaluation:
Baseline recorded as :
Liver mass > 1cm on CT or MR
Tumor Response on follow up triphasic CT / MR, clinical examination and serum biochemistry 1 month
following treatment and at subsequent 3-month intervals for Virst year and then biannually with
coinciding clinical and imaging
TACE with Drug-eluting Embolic Agents:
Arteriography of celiac and superior mesenteric arteries was performed to assess hepatic blood supply
and tumor blood supply
Of the 38 patients in RFA group, 7 received epirubicin, 31 received doxorubicin
Of the 51 patients in MWA group, 11 received epirubicin, 40 received doxorubicin
Statistical Analysis:
Demographic and disease characteristics compared using chi-squared tests or Fisher tests for
categorical variables or two-sample t tests or Wilcoxon rank sum tests for continuous variables
Survival analyses performed using Kaplan-Meier method, log-rank test, univariate and multivariate Cox
proportional hazards regression
Univariate Cox regression used for tumor progression free survival analysis
Local tumor response compared between treatment groups using ordinal or standard logistic regression

Outcome

On initial treatment,
complete response was seen
in 80.4% of tumors treated
with TACE + RFA and 76.6%
of tumors treated with TACE
+ MWA with no signiLicant
difference between the two
cohorts

Credits

SUMMARY BY:

Alyson Kil M.D., PGY1
Department of Radiology
Walter Reed National Military Medical Center/National Capital
Consortium

FULL CITATION:
Ginsburg, Michael, Zivin, Sean P., Wroblewski, Kristen, Doshi Taral, Vasnani, Raj J., Van Ha, Thuong G. Comparison of
Combination Therapies in the Management of Hepatocellular Carcinoma" Journal of Vascular Interventional Radiology" 26.3
(2015): 330-341.

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