Combined treatments in hepatocellular carcinoma: Time to put them in the guidelines?

Table 4 Available studies on the transarterial chemoembolization plus microwave ablation

Ref.	Treatment type, n (%)	Clinical scenario	Response rate (CR + PR) mRECIST	Outcome
Ni et al[59], 2020	TACE + MWA (546)	BCLC B	N/A	Median PFS: 6.5 mo. Median OS: 35 mo
Ni et al[121], 2019	TACE + MWA (349)	Up to 3 nodules, 5-8 cm diameter	77.1%	Median PFS: 4.8 mo. Median OS: 28 mo
Chen et al[47], 2017	TACE (96) vs TACE + MWA (48)	HCC ≤ 5 cm	46.3% vs 92.1%	2-yr PFS: 57.3% vs 10.4%; 2-yr OS: NS
Smolock et al[56], 2018	TACE (16) vs TACE + MWA (22)	HCC 3-5 cm	76% vs 95% (NS)	Median PFS: 4.2 mo vs 22.3 mo. Median OS: 14.8 mo vs 18.5 mo. 3-yr OS: 42.1% vs 79%
Zheng et al[57], 2018	TACE (166) vs TACE + MWA (92)	Solitary HCC > 5 cm; 2-3 nodules > 3 cm; 4-10 nodules regardless of size	55.4% vs 81.5%	Median PFS: 12.5 mo vs 26.6 mo. Median OS: 6.7 mo vs 17.1 mo. 3-yr OS: 11.4% vs 32.6%
Zhang et al[60], 2018	TACE (100) vs TACE + MWA (50)	BCLC-B	55% vs 74%. At 6-mo, including stable disease	Median PFS: 6.1 mo vs 10.1 mo. Median OS: 14.4 mo vs 18.5 mo. 3-yr OS: 42.1% vs 79%. 5-yr OS: 21% vs 67.7%
Wang et al[61], 2020	TACE (111) vs TACE + MWA (72)	Recurrent (post-surgery) BCLC-B	N/A	Median PFS: N/A. Median OS: 14.4 mo vs 26.7 mo. 5-yr PFS: 13.0% vs 21.7%. 5-yr OS: 27.9% vs 43.3%
Li et al[29], 2020	MWA (88) vs TACE + MWA (62)	BCLC-B	N/A	3-yr PFS: 34.5% vs 32.5% (NS). 3-yr OS: 47.6% vs 49.2% (NS)
Biederman et al[55], 2017	TACE + MWA (80) vs Radiation segmentectomy (41)	Unresectable, solitary, ≤ 3 cm	CR 82.5% vs 82.9% (NS)	Median PFS: 12.1 mo vs 11.1 mo (NS). 90-d mortality: 0% all groups. Median OS: N/A
Ni et al[59], 2020	TACE + Sorafenib (n = 75) vs TACE + Sorafenib + MWA (77)	BCLC C	12% vs 46.7%	Median PFS: 3 mo vs 6 mo. Median OS: 13 mo vs 19 mo
Sheta et al[64], 2016	TACE (20) vs TACE + RFA (20) vs TACE + MWA (10)	Unrsesectable, solitary	6-mo CR–50% vs 70% vs 80%	Median PFS: N/A. Median OS: N/A
Wei et al[63], 2020	TACE + MWA (48) vs TACE + Cryoablation (60)	BCLC B	73.3% vs 33.4%	Median PFS: 8.8 mo vs 9.3 mo (NS). Median OS: 20.9 vs 13 mo (NS)

TACE: Transarterial chemoembolization; MWA: Microwave ablation; RFA: Radiofrequency ablation; HCC: Hepatocellular carcinoma; BCLC: Barcelona Clinic Liver Cancer classification system; CR: Complete response; PR: Partial response according to the mRECIST criteria; PFS: Progression-free survival; OS: Overall survival; NS: Non-significant; N/A: Not available.