Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2020; 12(8): 355-368
Published online Aug 27, 2020. doi: 10.4240/wjgs.v12.i8.355
Drug-eluting beads transarterial chemoembolization sequentially combined with radiofrequency ablation in the treatment of untreated and recurrent hepatocellular carcinoma
Yan Zhang, Mei-Wu Zhang, Xiao-Xiang Fan, Da-Feng Mao, Quan-Hua Ding, Lu-Hui Zhuang, Shu-Yi Lv
Yan Zhang, Mei-Wu Zhang, Xiao-Xiang Fan, Da-Feng Mao, Lu-Hui Zhuang, Shu-Yi Lv, Department of Interventional Therapy, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo 315010, Zhejiang Province, China
Yan Zhang, Mei-Wu Zhang, Xiao-Xiang Fan, Da-Feng Mao, Lu-Hui Zhuang, Shu-Yi Lv, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo 315010, Zhejiang Province, China
Yan Zhang, Mei-Wu Zhang, Xiao-Xiang Fan, Da-Feng Mao, Lu-Hui Zhuang, Shu-Yi Lv, Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Ningbo 315010, Zhejiang Province, China
Quan-Hua Ding, Department of Gastroenterology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo 315010, Zhejiang Province, China
Author contributions: Zhang MW was the guarantor and designed the study; Zhang Y, Zhang MW, Fan XX, Mao DF, and Ding QH designed the research; Zhang Y, Zhang MW, Fan XX, Mao DF, Ding QH, Zhuang LH, and Lv SY performed the research; Fan XX, Mao DF, and Ding QH contributed new analytic tools; Fan XX, Mao DF, Zhuang LH, and Lv SY analyzed data; Zhang Y, Zhang MW, Fan XX, Mao DF, and Ding QH wrote the paper and revised the article critically for important intellectual content.
Supported by Medical and Health Science and Technology Foundation of Zhejiang Province, No. 2017KY590 and No. 2019KY175; and Ningbo Clinical Research Center for Digestive System Tumors, No. 2019A21003.
Institutional review board statement: The study was approved by the ethics committee of Hwa Mei Hospital, University of Chinese Academy of Sciences.
Informed consent statement: All patients gave informed consent.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement, and the manuscript was prepared and revised according to the STROBE Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Mei-Wu Zhang, MD, Associate Chief Physician, Department of Interventional Therapy, Hwa Mei Hospital, University of Chinese Academy of Sciences, No. 41 Xibei Street, Haishu District, Ningbo 315010, Zhejiang Province, China. zhangmeiwu@163.com
Received: April 7, 2020
Peer-review started: April 7, 2020
First decision: May 5, 2020
Revised: May 8, 2020
Accepted: July 19, 2020
Article in press: July 19, 2020
Published online: August 27, 2020
Processing time: 136 Days and 1.7 Hours
Abstract
BACKGROUND

Drug-eluting beads transarterial chemoem-bolization (DEB-TACE) has the advantages of slow and steady release, high local concentration, and low incidence of adverse drug reactions compared to the traditional TACE. DEB-TACE combined with sequentially ultrasound-guided radiofrequency ablation (RFA) therapy has strong anti-cancer effects and little side effects, but there are fewer related long-term studies until now.

AIM

To explore the outcome of DEB-TACE sequentially combined with RFA for patients with primary hepatocellular carcinoma (HCC).

METHODS

Seventy-six patients with primary HCC who underwent DEB-TACE sequentially combined with RFA were recruited. Forty patients with untreated HCC were included in Group A, and 36 patients with recurrent HCC were included in Group B. In addition, 40 patients with untreated HCC who were treated with hepatectomy were included in Group C. The serological examination, preoperative magnetic resonance imaging examination, and post-treatment computed tomography enhanced examination were performed for all patients. The efficacy was graded as complete remission (CR), partial remission (PR), stable disease and progressive disease at the 3rd, 6th, and 9th. All patients were followed up for 3 years and their overall survival (OS), disease-free survival (DFS) were assessed.

RESULTS

The efficacy of Group A and Group C was similar (P > 0.05), but the alanine aminotransferase, aspartate aminotransferase and total bilirubin of Group A were lower than those of Group C (all P < 0.05). The proportions of CR (32.5%), PR (37.5%) were slightly higher than Group A (CR: 27.5%, PR: 35%), but the difference was not statistically significant (χ2 = 0.701, P = 0.873). No operational-related deaths occurred in Group A and Group C. The OS (97.5%, 84.7%, and 66.1%) and the DFS (75.0%, 51.7%, and 35.4%) of Group A at the 1st, 2nd, and 3rd year after treatment were similar with those of Group C (OS: 90.0%, 79.7%, and 63.8%; DFS: 80.0%, 59.7%, and 48.6%; P > 0.05). The OS rates in Group A and Group B (90%, 82.3%, and 66.4%) were similar (P > 0.05). The DFS rates in Group B (50%, 31.6%, and 17.2%) were lower than that of Group A (P = 0.013).

CONCLUSION

The efficacy of DEA-TACE combined with RFA for untreated HCC is similar with hepatectomy. Patients with recurrent HCC could get a longer survival time through the combined treatment.

Keywords: Drug-eluting beads transarterial chemoembolization; Ultrasound; Radiofrequency ablation; Hepatocellular carcinoma; Untreated; Recurrent

Core tip: Drug-eluting beads transarterial chemoembolization (DEB-TACE) can continuously and slowly release chemotherapeutic drugs compared to traditional TACE. It can maintain higher local concentrations meanwhile reducing the adverse drug reactions. DEB-TACE combined with ultrasound-guided radiofrequency ablation (RFA) has a strong anti-cancer effect, but due to its expensive price, there are fewer clinical studies. This study explored the outcome of DEA-TACE combined with RFA in the treatment of primary and recurrent hepatocellular carcinoma (HCC). The results indicated that the outcome of combined treatment for untreated HCC was comparable to hepatectomy, with less bleeding, faster recovery, and less damage to liver function. More importantly, the combination therapy has a positive effect on the treatment of recurrent HCC with fewer complications and can prolong the survival time of patients.