The combination of embolization and radiofrequency ablation may be as effective as surgery for treating single liver cancer tumors up to 7 cm in diameter, according to a presentation at the 29th Annual Scientific Meeting of the Society of Interventional Radiology. In addition to equal efficacy, the minimally invasive procedure also offers an easier and much quicker recovery than surgery.

The current study included all patients with solitary hepatocellular carcinoma undergoing either surgical resection or embolization followed by radiofrequency ablation between January 1996 and August 2002 at a single U.S. cancer center. Only patients with liver tumors less than 7 cm were included. The study involved 40 patients who had surgical resection and 33 who had embolization plus ablation. There were significantly more patients with more advanced liver disease (Okuda stage II) in the embolization group than in the surgery group (36 percent versus 0 percent).

Median follow-up was 22 months for the embolization group and 23 months for the surgery group. The 1,2, 4, and 5 year survival rates for the combined treatment were 97%, 83%, 77% and 56% versus 81%, 70%, 70% and 57% for the surgery group.

Of the 19 surgical patients who developed recurrent disease, 7 subsequently underwent embolization as salvage therapy. Quite notably, despite the advanced stage of the liver tumors, 4 out of these 7 are currently alive with no evidence of active disease at 12, 16, 19, and 30 months from date of recurrence and 2 other patients are currently alive with disease and remain candidates for further embolization and/or ablation.

“The majority of the patients who have surgery will have recurrence of their cancer, because they still have cirrhosis and hepatitis. Repeat surgery is often not possible, so finding another way to treat them is important,” said presenter Anne M. Covey, MD.

Primary liver cancer most commonly occurs in the setting of underlying liver disease or cirrhosis due to hepatitis. Currently surgery offers the best chance for a cure. However, patients with primary liver cancer often present with other medical problems or with liver disease that makes them high-risk candidates for surgery. In fact, surgical resection is possible in fewer than 20% of cases, making alternative therapies imperative. Chemotherapy drugs are generally inactive against primary liver cancer.

“This new treatment takes two well-established interventional radiology procedures and combines them to optimize treatment for patients with primary liver cancer. Although surgical resection has historically been considered the gold standard for the treatment of patients with single lesions, the survival data are promising, and we remain cautiously optimistic that these results will hold up in the long-term,” said presenter Anne M. Covey, MD.

“Although more studies are needed, this study is significant because it compares the combined interventional radiology techniques to surgical resection within a tertiary care facility with equal experience in tumor embolization and surgery, broadening the applicability of the interventional techniques in the treatment of primary liver cancer. A multi-disciplinary approach is imperative,” said Covey.