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Title: Analysis on efficacy and safety of TACE in combination with RFA and MWA in the treatment of middle and large primary hepatic carcinoma.
Author: Yuan P, Zhang Z, Kuai J.
Journal: J BUON; 2019; 24(1):163-170. PubMed ID: 30941966.
Abstract:
PURPOSE: To compare and explore the efficacy and safety of transcatheter arterial chemoembolization (TACE) in combination with radiofrequency ablation (RFA) and microwave ablation (MWA) in the treatment of middle and large primary hepatic carcinoma. METHODS: A retrospective analysis was made on 75 patients with middle and large hepatic carcinoma (tumor diameter ≥3 cm) receiving TACE in combination with thermal ablation therapy in our hospital from January 2012 to January 2015, with hepatic function Child-Pugh class A and B. Forty-one cases received TACE+RFA, while 34 cases received TACE+MWA. Patients in both groups were followed up to observe the short-term efficacy, 3-year survival rate, alpha fetoprotein (AFP), indexes of hepatic function and incidence of adverse reactions. RESULTS: No statistical differences was noted in preoperative general conditions between the two groups of patients. The results showed 28 cases of complete response (CR) and 13 cases of partial response (PR) in the TACE+RFA group, and 29 cases of CR and 5 cases of PR in the TACE+MWA group. The difference in the short-term efficacy between two groups was not significant (p>0.05). With tumor diameter 3-5 cm, there was no statistically significant difference in the efficacy between the two groups (p>0.05), and with tumor diameter over 5 cm, the efficacy in TACE+MWA group was significantly better than that in TACE+RFA group (p=0.041). After treatment, the level of AFP in both groups was decreased in different degrees but without statistical significance (p>0.05). The levels of ALT and AST of hepatic functions in both groups increased after treatment. The postoperative average levels of ALT and AST in the TACE+RFA group were 85.90±49.02 U/L and 113.53±56.54 U/L, respectively, which were significantly lower than those in the TACE+MWA group (138.62±69.04 U/L and 178.03±104.50 U/L; p<0.05). During follow-up, the 1-, 2- and 3-year cumulative survival rates in the TACE+RFA group were 68.30, 36.60 and 14.60%, and those in TACE+MWA group were 79.40, 53.00 and 38.20%. The tumor-free survival rates in the TACE+RFA group were 53.70, 29.30 and 12.20%, and those in TACE+MWA group were 58.80, 38.20 and 29.40%. The difference in survival rate between two groups had no statistical significance (p>0.05). The differences in postoperative adverse reactions and follow-up conditions between two groups were not statistically significant (p>0.05). CONCLUSIONS: The difference in the short-term efficacy between the TACE+RFA and TACE+MWA group in the treatment of middle and large primary hepatic carcinoma had no statistical significance. When the tumor size was over 5 cm, the efficacy in TACE+MWA group was better than that in TACE+RFA group. There were no obvious differences in 1-year cumulative survival rate and tumor-free survival rate between the two groups, but postoperative liver function damage in the TACE+RFA group was lighter than that in TACE+MWA group.

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