Giving liver cancer patients two common treatments rather than one allows them to live one year longer, a new study says.
In the study of 291 patients, researchers concluded that the two treatments extended life expectancy to 37 months, from an average of 22 to 24 months.
The two treatments are:
- Transcatheter arterial chemoembolization (TACE), which is targeted chemotherapy that also cuts off the blood supply to the tumour.
- Radiofrequency ablation (RFA), which kills tumour cells with radiofrequency waves delivered straight into the tumour by a probe.
Neither treatment is effective on its own against tumours larger than 3 cm, the researchers said in their study. So Dr. Bao-Quan Cheng and colleagues from Shandong University in Jinan, China, conducted the trial on the effects of the two treatments together on tumours larger than that.
The researchers assigned study subjects to three groups in their trial: those that would receive only TACE, only RFA or both.
At the end of the study, which lasted almost three-and-a-half years, 84 per cent of the patients in both the TACE and the RFA group had died, while 69 per cent had died in the group that received both treatments. Researchers found that fewer patients in the combined treatment group died because their tumours didn't progress.
In their conclusion, the study's authors wrote: "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 study was published in the April 9 edition of the Journal of the American Medical Association.
Abstract:
Chemoembolization Combined With Radiofrequency Ablation for Patients With Hepatocellular Carcinoma Larger Than 3 cm A Randomized Controlled Trial
Bao-Quan Cheng, MD, PhD, Chong-Qi Jia, PhD, Chun-Tao Liu, MD, Wei Fan, MD, Qing-Liang Wang, MD, Zong-Li Zhang, MD, PhD, Cui-Hua Yi, MD, PhD
Context Transarterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) therapy has been used for patients with large hepatocellular carcinoma tumors, but the survival benefits of combined treatment are not known.
Objective To compare rates of survival of patients with large hepatocellular carcinoma tumors who received treatment with TACE combined with RFA therapy (TACE-RFA), TACE alone, and RFA alone.
Design, Setting, and Patients Randomized controlled trial conducted from January 2001 to May 2004 among 291 consecutive patients with hepatocellular carcinoma larger than 3 cm at a single center in China.
Intervention Patients were randomly assigned to treatment with combined TACE-RFA (n=96), TACE alone (n=95), or RFA alone (n=100).
Main Outcome Measures The primary end point was survival and the secondary end point was objective response rate.
Results During a median 28.5 months of follow-up, median survival times were 24 months in the TACE group (3.4 courses), 22 months in the RFA group (3.6 courses), and 37 months in the TACE-RFA group (4.4 courses). Patients treated with TACERFA had better overall survival than those treated with TACE alone (hazard ratio [HR], 1.87; 95% confidence interval [CI], 1.33-2.63; P_.001) or RFA (HR, 1.88; 95% CI, 1.34-2.65; P_.001). In a preplanned substratification analysis, survival was also better in the TACE-RFA group than in the RFA group for patients with uninodular hepatocellular carcinoma (HR, 2.50; 95% CI, 1.42-4.42; P=.001) and in the TACE-RFA group than the TACE group for patients with multinodular hepatocellular carcinoma (HR, 1.99; 95% CI, 1.31-3.00; P_.001). The rate of objective response sustained for at least 6 months was higher in the TACE-RFA group (54%) than with either TACE (35%; rate difference, 0.19; 95% CI, 0.06-0.33; P=.009) or RFA (36%; rate difference, 0.18; 95% CI, 0.05-0.32; P=.01) treatment alone.
Conclusion In this patient group, TACE-RFA was superior to TACE alone or RFA alone in improving survival for patients with hepatocellular carcinoma larger than 3 cm.
