Comparison  of  Combina-on  Therapies  in  the  Management  of  Hepatocellular  Carcinoma:  Transarterial  Chemoemboliza-on  with  Radiofrequency  Abla-on  versus  Microwave  Abla-on  SIR-­‐RFS  Journal  Primer  

BOTTOM  LINE  •  Based   on   a   retrospective   study   on   89   patients,   transarterial   chemoembolization  with   RF   ablation  

and   transarterial   chemoembolization   with   MW   ablation   are   both   effective   treatments   for  hepatocellular  carcinoma.      

MAJOR  POINTS    •  Complete   local   tumor   response   was   achieved   in   80.4%   of   tumors   treated   with   TACE   +   RFA   and  

76.6%  treated  with  TACE  +  MWA  

•  Median  progression  free  survival  was  9.3  mo  with  TACE  +  RFA  and  9.2  mo  for  TACE  +  MWA  

•  Median  tumor  progression  free  survival  was  20.8  mo  for  TACE  +  RFA  and  21.8  mo  for  TACE  +  MWA  

CRITICISM    

•  Small  sample  size:  n  =  89  at  a  single  institution  

•  Study  was  retrospective  nature    

•  Complexity  of  liver  disease  made  multivariate  analysis  difVicult    

•  Short   follow-­‐up   period:   TACE   +   MWA   class   had   shorter   follow   up   which   may   have   limited   the  accurate  evaluation  of  long-­‐term  efVicacy    

 

Quick  Summary  

SINGLE  CENTER  RETROSPECTIVE  REVIEW  •  89  patients  with  hepatocellular  carcinoma  treated  with  TACE  +  RFA  (38)  and  

TACE  +  MWA  (51)  from  November  1,  2003  –  November  1,  2011    INCLUSION  CRITERIA  •  Ages  34-­‐89  •  HCC  diagnosed  by  presence  of  hypervascular  liver  mass  >  1cm  with  arterial  

uptake  followed  by  “washout”  of  contrast  in  the  venous-­‐delayed  phases  on  either  multiphase  CT  or  MRI  in  accordance  with  AASLD    

•  Disease  burden  was  staged  using  Child-­‐Pugh  criteria,  UNOS  and  BCLC  classiVications  

 EXCLUSION  CRITERIA  •  Evidence  of  distant  metastasis    

Study  design  

To  retrospectively  compare  the  outcomes  and  complications  of  transcatheter  transarterial  chemoembolization  with  drug-­‐eluting  embolic  agents  combined  with  RFA  vs  transcatheter  transarterial  chemoembolization  with  drug-­‐eluting  embolic  agents  combined  with  MWA  in  the  treatment  of  HCC  

Purpose  

All  subjects  had  HCC    Tumor  Evaluation:  »  Baseline  recorded  as  :        Liver  mass  >  1cm  on  CT  or  MR    

§  Tumor  Response  on  follow  up  triphasic    CT  /  MR,  clinical  examination  and  serum  biochemistry  1  month  following  treatment  and  at  subsequent  3-­‐month  intervals  for  Virst  year  and  then  biannually  with  coinciding  clinical  and  imaging    

TACE  with  Drug-­‐eluting  Embolic  Agents:  »  Arteriography  of  celiac  and  superior  mesenteric  arteries  was  performed  to  assess  hepatic  blood  supply  

and  tumor  blood  supply  »  Of  the  38  patients  in  RFA  group,  7  received  epirubicin,  31  received  doxorubicin  

»  Of  the  51  patients  in  MWA  group,  11  received  epirubicin,  40  received  doxorubicin  Statistical  Analysis:  »  Demographic  and  disease  characteristics  compared  using  chi-­‐squared  tests  or  Fisher  tests  for  

categorical  variables  or  two-­‐sample  t  tests  or  Wilcoxon  rank  sum  tests  for  continuous  variables  »  Survival  analyses  performed  using  Kaplan-­‐Meier  method,  log-­‐rank  test,  univariate  and  multivariate  Cox  

proportional  hazards  regression  »  Univariate  Cox  regression  used  for  tumor  progression  free  survival  analysis  

»  Local  tumor  response  compared  between  treatment  groups  using  ordinal  or  standard  logistic  regression      

Interven7on:  TACE  +  RFA  and  TACE  +  MWA  89  pa7ents    

On  initial  treatment,  complete  response  was  seen  in  80.4%  of  tumors  treated  with  TACE  +  RFA  and  76.6%  of  tumors  treated  with  TACE  +  MWA  with  no  signiLicant  difference  between  the  two  

cohorts    

Outcome    

Credits  

SUMMARY  BY:    Alyson  Kil  M.D.,  PGY1  Department  of  Radiology  Walter  Reed  National  Military  Medical  Center/National  Capital  Consortium    FULL  CITATION:  Ginsburg,  Michael,  Zivin,  Sean  P.,  Wroblewski,  Kristen,  Doshi  Taral,  Vasnani,  Raj  J.,  Van  Ha,  Thuong  G.  “Comparison  of  Combination  Therapies  in  the  Management  of  Hepatocellular  Carcinoma"  Journal  of  Vascular  Interventional  Radiology"  26.3  (2015):  330-­‐341.  

Society  of  Interven7onal  Radiology  3975  Fair  Ridge  Drive    |    Suite  400  North    Fairfax,  VA  22033  (703)  460-­‐5583    

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