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Title: Combination Therapy Improves Survival in Patients With Advanced Hepatocellular Cancer
URL: http://www.pslgroup.com/dg/21F3BA.htm
Doctor's Guide
April 8, 2008

CHICAGO -- April 8, 2008 -- Combining a type of chemotherapy with radiothermal therapy resulted in longer survival time for patients with advanced hepatocellular cancer compared with those receiving either therapy alone. The findings are published in the April 9 issue of JAMA.

The therapy, called transcatheter arterial chemoembolization (TACE), slows tumour progression and improves survival by combining the effect of targeted chemotherapy with that of blocking the blood supply to the tumour. Radiofrequency thermal ablation (RFA) is an emerging technology that typically is performed by advancing a specially designed probe into the tumour and applying radiofrequency energy. However, both TACE and RFA have limitations, with neither resulting in adequate control of liver cancer tumours >3 cm (1.2 in). TACE combined with RFA therapy has been used for patients with large liver cancer tumours, but the survival benefits are not known.

Bao-Quan Cheng, MD, PhD, and colleagues from Shandong University, Jinan, China, conducted a randomised controlled trial to assess the long-term benefits of combining TACE and RFA therapies for hepatocellular tumours >3 cm. The trial was conducted from January 2001 to May 2004 and included 291 patients at a single centre 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%), 84 in the RFA group (84%), and 66 in the TACE-RFA group (69%) had died. The lower rate of death in the TACE-RFA group was the result of fewer deaths due to tumour progression in this group. Median 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 either the TACE (P < .001) or RFA groups (P < .001).

For patients with uninodular and multinodular hepatocellular cancer, overall survival was statistically significantly better in the TACE-RFA group than in the RFA group for uninodular cancer (P = .01) and than the TACE group for multinodular cancer (P < .001).

Thirty-three patients (35%) achieved an objective response to treatment for at least 6 months in the TACE group, 36 (36%) in the RFA group, and 52 (54%) 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 larger than 3 cm," the authors concluded.


SOURCE: JAMA, April 9, 2008

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