SIR- RFS Journal Primer

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1 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

2 Quick Summary 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

3 Study design 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 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

4 Purpose 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

5 Interven7on: TACE + RFA and TACE + MWA 89 pa7ents 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

6 Outcome 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

7 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):

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