Combined transarterial chemoembolization and radiofrequency ablation for hepatocellular carcinoma

Transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) are both efficacious in treating well-selected patients who have hepatocellular carcinoma (HCC). The sequential combination of these two modalities has a sound theoretical basis and raises the probability of complete local response in tumors that are beyond the size at which the likelihood of failure with RFA alone begins to rise. Cheng et al. have found that when limited to patients with well-compensated liver disease, combined TACE and RFA does not seem to dramatically increase the risk of complications beyond the risk levels associated with the individual procedures. The survival benefit demonstrated in this recent article is, however, an artifact of a rigid study design that did not allow rational selection of treatment on the basis of individual patient and tumor characteristics. This study bolsters the evidence that the combination of TACE with RFA enhances local response, strengthening the status of nonsurgical treatment compared with resection for the treatment of early HCC.