Combining a type of chemotherapy with radiothermal therapy resulted in longer survival time for patients with advanced liver cancer, compared to receiving the therapies alone, according to a study in the April 9 issue of JAMA.
The incidence of liver cancer is increasing worldwide. Most liver cancers are diagnosed at intermediate or advanced stages, and until now, no standard therapy has been established for treatment of liver cancer, according to background information in the article.
The therapy called transcatheter arterial chemoembolization (TACE) slows tumor progression and improves survival by combining the effect of targeted chemotherapy with that of blocking the blood supply to the tumor. Radiofrequency thermal ablation (RFA) is an emerging technology that typically is performed by advancing a specially designed probe into the tumor and applying radiofrequency energy. However, both TACE and RFA have limitations, with neither resulting in adequate control of liver cancer tumors larger than 3 cm (1.2 inches). TACE combined with RFA therapy has been used for patients with large liver cancer tumors, but the survival benefits are not known.
Bao-Quan Cheng, M.D., Ph.D., and colleagues from Shandong University, Jinan, China, conducted a randomized controlled trial to assess the long-term benefits of combining TACE and RFA therapies for liver cancer tumors larger than 3 cm. The trial was conducted from January 2001 to May 2004 and included 291 patients at a single center in China. Patients were randomly assigned to treatment with combined TACE-RFA (n = 96), TACE alone (n = 95), or RFA alone (n = 100).
At the end of follow-up, 80 patients in the TACE group (84 percent), 84 in the RFA group (84 percent), and 66 in the TACE-RFA group (69 percent) had died. The lower rate of death in the TACE-RFA group was the result of fewer deaths due to tumor progression in this group than in the TACE group or the RFA group. Median (midpoint) survival times were 24 months in the TACE group, 22 months in the RFA group, and 37 months in TACE-RFA group. Survival rates were significantly better in the TACE-RFA group than in the TACE or RFA group.
For patients with a type of liver cancer known as uninodular or multinodular, overall survival was statistically significantly better in the TACE-RFA group than in the RFA group, and TACE group, respectively.
Thirty-three patients (35 percent) achieved an objective response to treatment that was sustained for at least six months in the TACE group, 36 (36 percent) in the RFA group, and 52 (54 percent) in the TACE-RFA group.
“The current study demonstrates that combination therapy with TACE and RFA was an effective and safe treatment that may improve long-term survival for patients with hepatocellular carcinoma [liver cancer] larger than 3 cm,” the authors conclude.
(JAMA. 2008;299[14]:1669-1677. Available pre-embargo to the media at www.jamamedia.org)
Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Editorial: Expanding the Treatment Options for Hepatocellular Carcinoma
In an accompanying editorial, Andrew X. Zhu, M.D., Ph.D., of the Massachusetts General Hospital Cancer Center, and Harvard Medical School, Boston, and Ghassan K. Abou-Alfa, M.D., of Memorial Sloan-Kettering Cancer Center, New York, write that these findings are promising.
“The study by Cheng et al provides initial evidence to support the use of TACE-RFA as a new treatment option in highly selected patients with unresectable [unable to be removed by surgery] hepatocellular carcinoma [HCC]. … However, despite the positive findings in this study, the exact role for TACE-RFA in the treatment of patients with unresectable HCC remains a controversial and unresolved issue, similar to the situation for many of the interventional-based therapies.”
(JAMA. 2008;299[14]:1716-1717. Available pre-embargo to the media at www.jamamedia.org)
Editor’s Note: Please see the article for additional information, including financial disclosures, funding and support, etc.
Journal
JAMA