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Combined therapy with conventional trans-arterial chemoembolization (cTACE) and microwave ablation (MWA) for hepatocellular carcinoma >3–<5 cm
International Journal of Hyperthermia ( IF 3.0 ) Pub Date : 2021-02-21 , DOI: 10.1080/02656736.2021.1887941
Mohamed M A Zaitoun 1, 2 , Saeed B Elsayed 1 , Nahla A Zaitoun 3 , Radwa K Soliman 4 , Ali H Elmokadem 5 , Alaa A Farag 6 , Mahmoud Amer 6 , Ali M Hendi 7 , Nader E M Mahmoud 1 , Dalia Salah El Deen 1 , Ahmed M Alsowey 1 , Shahenda Shahin 1 , Mohammad Abd Alkhalik Basha 1
Affiliation  

Abstract

Purpose

To compare safety and efficacy of combined therapy with conventional transarterial chemoembolization (cTACE)+microwave ablation (MWA) versus only TACE or MWA for treatment of hepatocellular carcinoma (HCC) >3–<5 cm.

Methods

This randomized controlled trial (NCT04721470) screened 278 patients with HCC >3–<5 cm. Patients were randomized into three groups: 90 underwent TACE (Group 1); 95 underwent MWA (Group 2); and 93 underwent combined therapy (Group 3). Patients were followed-up with contrast-enhanced CT or MRI. Images were evaluated and compared for treatment response and adverse events based on modified response evaluation criteria in solid tumor. Serum alpha-fetoprotein (AFP) concentration was measured at baseline and during every follow-up visit.

Results

Final analysis included 265 patients (154 men, 111 women; mean age = 54.5 ± 11.8 years; range = 38–76 years). Complete response was achieved by 86.5% of patients who received combined therapy compared with 54.8% with only TACE and 56.5% with only MWA (p = 0.0002). The recurrence rate after 12 months was significantly lower in Group 3 (22.47%) than Groups 1 (60.7%) and 2 (51.1%) (p = 0.0001). The overall survival rate (three years after therapy) was significantly higher in Group 3 (69.6%) than Groups 1 (54.7%) and 2 (54.3%) (p = 0.02). The mean progression-free survival was significantly higher in Group 3 than groups 1 and 2 (p < 0.001). A decrease in AFP concentration was seen in 75%, 63%, and 48% patients of Group 3, 2, and 1, respectively.

Conclusions

Combined therapy with cTACE + MWA is safe, well-tolerated, and more effective than TACE or MWA alone for treatment of HCC >3–<5 cm.



中文翻译:

常规肝动脉化疗栓塞(cTACE)和微波消融(MWA)联合治疗> 3– <5 cm肝细胞癌

摘要

目的

比较传统经动脉化学栓塞(cTACE)+微波消融(MWA)与仅使用TACE或MWA联合治疗肝细胞癌(HCC)> 3– <5 cm的安全性和有效性。

方法

这项随机对照试验(NCT04721470)对278例HCC> 3– <5 cm的患者进行了筛查。将患者随机分为三组:90例行TACE治疗(第1组);95名进行了MWA(第2组);93例接受了联合治疗(第3组)。对患者进行对比增强的CT或MRI随访。根据实体瘤中经过修改的反应评估标准,评估并比较图像的治疗反应和不良事件。在基线和每次随访期间测量血清甲胎蛋白(AFP)浓度。

结果

最终分析包括265位患者(154位男性,111位女性;平均年龄= 54.5±11.8岁;范围= 38-76岁)。接受联合治疗的患者中有86.5%的患者获得了完全缓解,而仅使用TACE的患者为54.8%,仅接受MWA的患者为56.5%(p  = 0.0002)。第3组(12.47%)在12个月后的复发率显着低于第1组(60.7%)和第2组(51.1%)(p  = 0.0001)。第三组(69.6%)的总生存率(治疗后三年)明显高于第一组(54.7%)和第二组(54.3%)(p  = 0.02)。第3组的平均无进展生存期明显高于第1组和第2组(p <0.001)。组3、2和1的患者中AFP浓度分别下降了75%,63%和48%。

结论

与单独的TACE或MWA联合使用cTACE + MWA的联合治疗安全性高,耐受性好,并且比单独使用TACE或MWA更有效。

更新日期:2021-02-22
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