By combining one type of chemotherapy with another radiothermal therapy, medical scientists were able to improve the survival time for patients with advanced liver cancer in comparison to each therapy alone, according to a study published on April 9, 2008 in JAMA.

Liver cancer is characterized by tumors or growth on the liver, and its incidence is increasing worldwide. Most of these cancers are not diagnosed until intermediate or advanced stages and, until now, there has been no standard therapy established for treatment. 

The therapy called transcatheter arterial chemoembolization (TACE) slows the progression of tumors and improved survival rates for patients by combining two effects: that of targeted chemotherapy with blockage of the blood supply to the tumor. Another therapy, radiofrequency thermal ablation (RFA) is a newer technology that is usually performed using a specially designed probe to apply radiofrequency energy after insertion into the tumor. Both TACE and RFA have some limitations and neither satisfactorily controls liver cancer tumors that are larger than 1.2 inches (3cm). The survival benefits for TACE used in combination with RFA therapy have not previously been studied.

Bao-Quan Cheng, M.D., Ph.D., and colleagues from Shandong University, Jinan, China, performed a randomized, controlled trial assessing the long-term benfits of combination TACE and RFA therapies for liver cancer tumors that are larger than 3cm. In this trial, 291 patients were examined between January 2001 and May 2004 at a single center in China. The subjects were randomly assigned to combined treatment (96 patients), TACE alone (95 patients), or RFA alone (100 patients). They were followed up for a median 28.5 months and the survival rates of the patients were calculated.

After follow up, 69% of the TACE and RFA group had died. This was true for 84% of the TACE only group, and for 84% of the RFA only group. This lower rate of death in the combination group was the result of a decreased number of deaths due to tumor progression.

The median survival time for the group given combination therapy was 37 months, while only 24 months in the TACE group and 22 months in the RFA group. This shows significant improvement in the survival rates in TACE and RFA treated patients.

54% of the patients in the combination group achieved an objective response to treatment that was sustained for at least 6 months. In contrast, this was true for 35% of the TACE patients and 36% of the RFA group.

Patients with a type of liver cancer called uninodular or multinodular, the overall survival was especially improved when given combination therapy, in contrast the RFA or TACE groups.

The authors indicate optimism at the potential this new therapy holds for patients with liver cancer. "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 [liver cancer] larger than 3 cm," they say.

Andrew X. Zhu, M.D., Ph.D., of the Massachusetts General Hospital Cancer Center, and Harvard Medical School, Boston, and Ghassan K. Abou-Alfa, M.D., of Memorial Sloan-Kettering Cancer Center, New York, contribeted an accompanying editorial in which they state that these findings are indeed 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 [unable to be removed by surgery] hepatocellular carcinoma [HCC]. ...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."

Chemoembolization Combined With Radiofrequency Ablation for Patients With Hepatocellular Carcinoma Larger Than 3 cm: A Randomized Controlled Trial
Bao-Quan Cheng; Chong-Qi Jia; Chun-Tao Liu; Wei Fan; Qing-Liang Wang; Zong-Li Zhang; Cui-Hua Yi
JAMA. 2008;299(14):1669-1677.
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Expanding the Treatment Options for Hepatocellular Carcinoma: Combining Transarterial Chemoembolization With Radiofrequency Ablation
Andrew X. Zhu; Ghassan K. Abou-Alfa
JAMA. 2008;299(14):1716-1718.
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Anna Sophia McKenney