Combination of TACE plus RFA in early and intermediate stage HCC patients

Background Locoregional therapies are recommended therapies for patients with non-advanced stage hepatocellular carcinoma (HCC). While radiofrequency ablation (RFA) is used for early stage, transarterial chemoembolization (TACE) is the option for intermediate stage disease. The aim of this study was to compare the efficacy and safety of combination of TACE plus RFA with RFA or TACE alone in patients with non-advanced HCC. With new and markedly improved medical treatment options for liver cancer, identifying patients who profit from locoregional therapies is essential.

Methods Patients treated with combination of TACE plus RFA, patients treated with RFA alone and patients treated with TACE alone were included in this analysis. Progression free survival (PFS), overall survival (OS), adverse events (AEs) as well as prognostic scoring systems were analyzed in the three groups of patients treated at Klinikum Klagenfurt.

Results 29 patients were treated with TACE/RFA combination, 15 with RFA and 34 with TACE alone. ORR rate was equal in all groups. There was no statistical difference in, ORR, OS (RFA/TACE vs. RFA vs. TACE: 42 vs. 42 vs 26 months, p =  0.078) and PFS:(15 vs. 26 vs. 16 months, p = 0.845). However, serious adverse events (CTCAE ≥ grade 3) were significantly lower in patients treated with combination therapy compared to TACE alone (10 vs. 30 %, p = 0.034), due to fewer needed interventions in order to achieve objective response. In univariate analysis STATE score (15 vs. 52 months, p<0.001) had a significant prognostic impact for patients with TACE/RFA combination. Furthermore, STATE score predicted PFS (5 vs. 20 months, p = 0.006).

Conclusion The combination of TACE plus RFA showed the same effectiveness compared to RFA or TACE alone. However, safety was better compared to TACE. STATE score can identify optimal patients to be treated with this combination.

Publication History

Article published online:
01 September 2021