The combination of transcatheter arterial chemoembolization and radiofrequency thermal ablation improves survival of patients with advanced hepatocellular carcinoma compared with either treatment alone, according to an article in the April 9 issue of the Journal of the American Medical Association.

Both technologies alone have limitations in treatment of hepatocellular carcinoma, with neither resulting in adequate control of tumors larger than 3 cm. The therapies had been combined previously for patients with large tumors, but survival benefits were not known.

Bao-Quan Cheng, MD, PhD, and colleagues from Shandong University, Jinan, China, conducted a randomized controlled trial to assess long-term benefits of combining the two therapies for tumors larger than 3 cm. The trial was conducted from January 2001 to May 2004 and included 291 patients at a single center in China. Patients were randomized to combined treatment (96 patients), transcatheter chemoembolization alone (95 patients), or radiofrequency ablation alone (100 patients).

At the end of follow-up, 80 patients in the chemoembolization group (84 percent), 84 patients in the radiofrequency ablation group (84 percent), and 66 patients in the combination therapy group (69 percent) had died.

The lower rate of death in the combination therapy group was the result of fewer deaths due to tumor progression in this group compared with the other two groups. Median survival times were 24 months for chemoembolization, 22 months for radiofrequency ablation, and 37 months for combination therapy. Survival rates were significantly better for combination therapy than for either therapy alone.

For patients with uninodular or multinodular disease, overall survival was statistically significantly better in the combination therapy group than in either single therapy group.

Thirty-three patients (35 percent) achieved an objective response to treatment that was sustained for at least six months in the chemoembolization group versus 36 (36 percent) in the radiofrequency ablation group and 52 (54 percent) in the combination therapy group.

The authors concluded that "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."

In an accompanying editorial, Andrew X. Zhu, MD, PhD, of the Massachusetts General Hospital Cancer Center, and Harvard Medical School, Boston, and Ghassan K. Abou-Alfa, MD, of Memorial Sloan-Kettering Cancer Center, New York, wrote that the findings are promising.

"The study by Cheng et al provides initial evidence to support the use of TACE-RFA as a new treatment option in highly selected patients with unresectable hepatocellular carcinoma. ... However, despite the positive findings in this study, the exact role for TACE-RFA in the treatment of patients with unresectable HCC remains a controversial and unresolved issue, similar to the situation for many of the interventional-based therapies."