Chemoembolization Plus Radiofrequency Ablation Effective for Local Control of Liver Cancer

Peggy Peck

March 29, 2004

March 29, 2004 (Phoenix) — Combination chemoembolization and radiofrequency ablation (RFA) provides good local control of liver tumors up to 6 cm, but the treatment does not prevent metastases, according to researchers from the University of Pennsylvania in Philadelphia.

In a series of 32 tumors in 26 patients, overall survival at one year was 61%, but disease-free survival was 18%, said lead author Rajan Agarwal, AB, a fourth-year medical student who presented the findings here at the 29th annual meeting of the Society of Interventional Radiology. Senior author Michael C. Soulen, MD, associate professor of radiology at the University of Pennsylvania, told Medscape that the "Pennsylvania protocol" developed at his institution "requires RFA for tumors less than 3 cm, RFA plus chemoembolization for tumors 3 to 6 cm, and chemoembolization only for tumors greater than 6 cm."

The patients were embolized with cisplatin (100 mg)/adriamycin (50 mg)/mitomycin (10 mg)/ethiodol (10 cc)/polyvinyl alcohol (150 to 250 µm) followed by RFA the following day, Mr. Agarwal said. The RFA was done with either a 3.5-cm radial array and 90W generator or a 4-cm array and a 200W generator. Eighteen of the 32 tumors were hepatocellular carcinomas and 14 were metastases.

The technical success rate was 100%, but there were two major complications: left lobe infarct and abscess formation with bilicutaneous fistula. Tumor markers from 18 patients indicated 11 partial responses, two marginal responses, three patients remained stable, and two progressed.

Four of the patients received transplants within six months. Fifteen patients progressed elsewhere within 12 months of treatment: 10 had intrahepatic progression at new sites, three had extrahepatic progression, two had intra- and extrahepatic progression, and one patient had intrahepatic progression at a new site after 37 months.

During the discussion after Mr. Agarwal's presentation, Dr. Soulen said, "I think there is little doubt that we can give good local control with this method, but how this affects survival is still unclear."

He added that it is his impression that "when you add the chemoembolization, the patients, on average, do better."

Mr. Agarwal told Medscape that it is difficult to generalize the results because "it is a retrospective study from a single institution." Moreover, he said there was incomplete imaging follow-up in some patients and the tumors were heterogeneous, which also limits the ability to generalize the results.

SIR 29th Annual Meeting: Abstract 134. Presented March 28, 2004.

Reviewed by Gary D. Vogin, MD


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