Invasive Measures May Improve Outcome for Patients with Liver Cancer

A recent study reveals that a combination of chemoembolization and radiofrequency ablation is more effective than either treatment alone for patients with larger liver tumors. These findings were published in Journal of the American Medical Association.

Liver cancer begins in the cells of the liver. Although many forms of cancer are declining in the United States, liver cancer rates are rising, primarily due to the large number of individuals diagnosed with hepatitis C. Unfortunately, because liver cancer is rarely discovered early and is often difficult to treat with current treatment options, prognosis is poor. In most cases treatment is designed to minimize symptoms associated with liver cancer.

Current treatment options may include surgery or chemotherapy, however if the cancer is confined to the liver, other techniques such as transarterial chemoembolization (TACE) or radiofrequency ablation (RFA) may be used as well. Chemoembolization is designed to stop blood flow to the tumor. The lack of blood supply deprives the tumor of needed oxygen and nutrients, causing cell death. The blood flow is stopped by using small particles saturated with chemotherapy drugs that soak the tumor in chemotherapy for a prolonged period.

Radiofrequency ablation is a minimally invasion procedure in which a needle electrode is guided by ultrasound or computed tomography scan directly into the tumor. High frequency electrical currents are then passed through the electrode, creating heat, which destroys the cancerous cells. In the current study, researchers sought to determine if combining these two techniques for the treatment of larger (larger than 3 centimeters) liver tumors would improve the patient’s overall survival.

Researchers in China conducted the study during a three-year period among 291 patients diagnosed with liver cancer larger than 3 centimeters. Patients were randomly assigned to receive treatment with either TACE alone, RFA alone, or a combination of TACE and RFA. The goal of the study was to evaluate survival benefits as well as response rates to these various techniques.

  • After an average follow up of 28.5 months, the average survival times were 24 months among the patients who received TACE, 22 months for patients who received RFA, and 37 months among those who received TACE and RFA.
  • Further analysis revealed that treatment of multiple tumors within the liver with combination therapy produced better outcomes than treatment of single tumors with RFA or TACE alone.
  • Response rates that were sustained for six months were highest among patients treated with TACE and RFA (54%) compared with 35% for patients treated with TACE alone and 36% among patients treated with RFA alone.

Researchers were encouraged by the results, which indicated that for patients with larger liver tumors, a combination of TACE and RFA was successful in improving overall survival outcomes.

Reference: Cheng, B., Jia, C., Liu C., et al. Chemoembolization combined with radiofrequency ablation for patients with hepatocellular carcinoma larger than 3cm. Journal of the American Medical Association. 2008; 299(14): 1669-1677

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