Biochemical Response after 3-D Conformal Radiotherapy of Localized Prostate Cancer to a Total Dose of 66 Gy

BACKGROUND: Since the introduction of 3-D conformal radiotherapy (CRT) doses of /= 70 Gy should be considered. As a consequence of our earlier analysis a prospective multicenter treatment optimization protocol has been initiated in 1999. The protocol includes a risk-adapted dose increase from 70 Gy in low-risk patients to 74 Gy in high-risk patients including short-term androgen ablation.     

Radiotherapy Confined to the Tumor Bed Following Breast Conserving Surgery

BACKGROUND: The standard technique of radiotherapy (RT) after breast conserving surgery (BCS) is to treat the entire breast up to a total dose of 45-50 Gy with or without tumor bed boost. The majority of local recurrences occur in close proximity to the tumor bed. Thus, the necessity of whole breast radiotherapy has been questioned, and several centers have evaluated the feasibility and efficacy of sole tumor bed irradiation. The aim of this study was to review the current status, controversies, and future prospects of tumor bed irradiation alone after breast conserving surgery. MATERIAL AND METHODS: Published prospective trials evaluating the feasibility and efficacy of radiotherapy confined to the tumor bed following breast conserving surgery were reviewed in order to analyze treatment results. RESULTS: In three earlier studies, using tumor bed radiotherapy for unselected patients, the incidence of intra-breast relapse was reported in the range of 15.6-37%. However, in nine prospective phase I-II trials, sole brachytherapy (BT) with different dose rates, strict patient selection, and meticulous quality assurance, resulted in 95.6-100% local control rates. To date, only one phase III protocol has been initiated comparing the efficacy of tumor bed brachytherapy alone with conventional whole breast radiotherapy. The ideal extend of the planning target volume (PTV) for tumor bed radiotherapy alone has not been established yet. In most series, PTV was defined as the excision cavity with generous (1-3 cm) safety margins. Minimal requirement for PTV localization is the use of titanium clips to mark the walls of the excision cavity intraoperatively, but the combination of clip demarcation and three-dimensional (3-D) visual information obtained from cross-sectional images seems to be the best method to determine the target volume. 3-D virtual brachytherapy is also a promising method to minimize the chance of geographic miss. Recently developed techniques, such as intraoperative radiotherapy (IORT), as well as accelerated 3-D conformal external beam radiation therapy (3-D-CRT) were also found to be feasible for tumor bed radiotherapy alone. CONCLUSIONS: In spite of the existing arguments against limiting radiotherapy to the tumor bed after breast conserving surgery, results of phase I-II studies suggest that tumor bed radiotherapy alone might be an appropriate treatment option for selected breast cancer patients. Whole breast radiotherapy remains the standard radiation modality used in the treatment of breast cancer, and brachytherapy as the sole modality should be considered as investigational. Further phase-III trials are suggested to determine the equivalence of sole tumor bed radiotherapy, compared with whole breast radiotherapy. Preliminary results with recently developed techniques (CT-image based conformal brachytherapy, 3-D virtual brachytherapy, IORT, 3-D-CRT) are promising. However, more experience is required to define whether these methods might improve outcome for patients treated with tumor bed radiotherapy alone.     

Irradiation of TSH-secreting hypophyseal adenomas

Hypophyseal adenomas secreting TSH are very rare. In dependence on local symptoms, internal-endocrinological, neurosurgical, or radiotherapeutical treatment approaches are applied alone or in combination. A case of radiotherapy alone is presented which was performed successfully in a patient with TSH secreting hypophyseal adenoma. This case is compared with the rates of success of other therapy modalities by means of a detailed literature survey.     

Chemo-radiotherapy in advanced head and neck tumors. Personal experience]

From January 1981 through December 1983, 49 untreated patients with locally advanced head and neck cancers were randomized in two groups to receive different radiochemotherapy regimens. Group A, including 29 cases, received 4 cycles of induction chemotherapy with Bleomycin, Methotrexate and Hydroxyurea before definitive external radiotherapy (60 Gy); group B, including 20 patients, received the same total dose of radiotherapy but the 4 cycles of chemotherapy, as described above, were administered between the 20- and the 40-Gy doses. Both groups were compared with a control group treated in the same period with radiotherapy (60 Gy) alone. The response to treatment was evaluated at the end of chemotherapy or radiotherapy alone and at the end of combined regimens. Long-term survival rates were analyzed for all groups relative to complete tumor response, disease-free interval and time to disease progression. In our experience the radio-chemotherapy combination, according to the described schedules, failed to improve both local control and overall survival; the comparison with the control group does not suggest that induction or intercalated chemotherapy can increase long-term survival even if initial complete and partial response rates are high.     

Radiation therapy for head and neck cancer

Radiation therapy is the first choice of treatment for most of the early squamous cell carcinoma of the head and neck. Conventional radiotherapy however, contributes to the high local control rates only for carcinoma of the glottic larynx and the nasopharynx. Squamous cell carcinoma of the other sites cannot be sterilized easily only by external beam radiation therapy alone. Chemoradiotherapy, conformal three-dimensional radiotherapy and multi-daily fractionation are introduced clinically to improve local control and/or survival for radioresistant tumor. In this review, consensus report of radiation therapy for carcinoma of the larynx and pharynx, which was reached an agreement in JASTRO meeting in 1998, is introduced. The role of radiation therapy in the management of head and neck cancer in present and near future is also discussed.     

Increase in efficacy of cancer radiotherapy by combination with whole-body low dose irradiation

PURPOSE: Design of cancer radiotherapy protocol to reduce radiation dose and increase treatment efficacy in Lewis lung cancer (LLC) model. METHODS: C57BL/6J mice subcutaneously implanted with LLC were treated by conventional radiotherapy (2Gy x 6) combined with LDWBI (low dose whole-body irradiation; the second, third, fifth and sixth local doses of 2Gy each substituted by LDWBI with 0.075Gy) and/or gene therapy (intratumor injection of pEgr-IL-18-B7.1 plasmid 24 h before the first and fourth local doses). Immunologic mechanisms were explored. RESULTS: Cancer control was most significantly improved in the group receiving local radiotherapy combined with LDWBI and gene therapy as shown by prolongation of mean survival time by 60.4%, reduction in average tumor weight by 70.8%, decrease in pulmonary metastasis by 66.9% and decrease in intratumor angiogenesis by 64.8% as compared to local radiotherapy alone (p < 0.05). These changes in tumor growth and progression were accompanied with up-regulation of host immunity manifested by stimulated NK (natural killer) and CTL (cytotoxic T lymphocyte) activity, IFN (interferon)-gamma and TNF (tumor necrosis factor)-alpha secretion, PKC (protein kinase C)-theta activation and LAMP (lysosomal associated membrane protein)-1 expression. CONCLUSION: Combination of conventional radiotherapy with LDWBI and gene transfer could reduce total radiation dose by 2/3 and at the same time improve treatment efficacy of cancer accompanied with up-regulated host anticancer immunity.     

Localized Prostate Cancer in Elderly Patients Outcome after Radiation Therapy Compared to Matched Younger Patients

PURPOSE: To detect a difference in outcome (disease-specific survival, local tumor progression, late toxicity, quality of life) after curative radiotherapy for localized prostate cancer in elderly as compared to younger patients. PATIENTS AND METHODS: In a retrospective analysis 59 elderly patients (> 74 years old) were matched 1:2 with younger patients from the data base according to tumor stage, grading, pre-treatment PSA values and year of radiotherapy. Surviving patients were contacted to fill in a validated questionnaire for quality of life measurement (EORTC QLQ-C30). Median follow-up for elderly and younger patients was 5.2 and 4.5 years, respectively. RESULTS: Overall survival at 5 years was 66% for the elderly and 80% for younger patients. Intercurrent deaths were observed more frequently in the elderly population. There was no age-specific difference in disease-specific survival (78% vs 82%), late toxicity or quality of life. Clinically meaningful local tumor progression was observed in 15% and 14%, respectively, corresponding to data from the literature following hormonal ablation. CONCLUSIONS: There is no obvious difference in outcome including disease-specific survival, late toxicity and quality of life in elderly patients, compared to a matched younger population. A clinically meaningful local tumor progression following radiotherapy or hormonal ablation only is rare. Local radiotherapy or, alternatively, hormonal ablation is recommended to preserve local progression-free survival in elderly patients except for very early stage of disease (i.e. T1 G1-2 M0).     

Combined chemotherapy and radiotherapy: cyclophosphamide

Compared to the other chemotherapeutic preparations discussed today, cyclophosphamide in combination with radiotherapy is a relatively unproblematic substance. Despite the great number of experimental and clinical data, the evaluation does not prove an advantage of the combined therapy with cyclophosphamide and irradiation as against radiotherapy alone in local tumor treatment. This should give occasion to further experimental investigations in adequate models. On the other hand, the practice of combined treatment with irradiation and preparations containing cyclophosphamide should be reconsidered for those cases where local control of a tumor is the principal therapeutic aim.     

A comparison of treatment methods for germinal cell tumors of the testis other than pure seminoma

The results of three approaches to management of the regional lymphatics for Stage I and Stage II nonseminomatous testicular tumors were reviewed. For clinical Stage I disease, the results achieved with orchiectomy and radiation therapy alone are equal to those achieved with orchiectomy and lymphadenectomy. Although the results with preoperative radiotherapy and lymphadenectomy are slightly better, the lymphadenectomy almost always results in aspermia and infertility. The effectiveness of radiotherapy alone is determined by the volume of cancer. Local tumor control with irradiation is good if the tumor burden is relatively small. The local control rates, however, are diminished if the metastases are greater than 2 cm in diameter. The results with preoperative radiotherapy and lymphadenectomy for patients with clinical Stage II disease are superior to those achieved with either primary lymphadenectomy or radiotherapy alone.     

Increase in efficacy of cancer radiotherapy by combination with whole-body low dose irradiation

Purpose:Design of cancer radiotherapy protocol to reduce radiation dose and increase treatment efficacy in Lewis lung cancer (LLC) model.

Methods: C57BL/6J mice subcutaneously implanted with LLC were treated by conventional radiotherapy (2Gy × 6) combined with LDWBI (low dose whole-body irradiation; the second, third, fifth and sixth local doses of 2Gy each substituted by LDWBI with 0.075Gy) and/or gene therapy (intratumor injection of pEgr-IL-18-B7.1 plasmid 24 h before the first and fourth local doses). Immunologic mechanisms were explored.

Results: Cancer control was most significantly improved in the group receiving local radiotherapy combined with LDWBI and gene therapy as shown by prolongation of mean survival time by 60.4%, reduction in average tumor weight by 70.8%, decrease in pulmonary metastasis by 66.9% and decrease in intratumor angiogenesis by 64.8% as compared to local radiotherapy alone (p < 0.05). These changes in tumor growth and progression were accompanied with up-regulation of host immunity manifested by stimulated NK (natural killer) and CTL (cytotoxic T lymphocyte) activity, IFN (interferon)-gamma and TNF (tumor necrosis factor)-alpha secretion, PKC (protein kinase C)-theta activation and LAMP (lysosomal associated membrane protein)-1 expression.

Conclusion: Combination of conventional radiotherapy with LDWBI and gene transfer could reduce total radiation dose by 2/3 and at the same time improve treatment efficacy of cancer accompanied with up-regulated host anticancer immunity.     

Clinical results of a radiotherapy-surgery program analyzed in relation to risk factors in cancer of the breast

In the Radio Institute "O. Alberti" of Brescia from 1.1.73 to 31.12.79, 976 patients were treated with postoperative radiotherapy after radical mastectomy. The impact of therapy has been observed on the NED survival and evaluated for prognostic factors. The involvement of axillary lymph nodes appears to be the most relevant prognostic factor; the hormonal perimenopausal status was associated with a poorer prognosis both regarding the high frequency of axillary metastatic nodes and because in N+ 1-3 cases the probability of relapse is different and higher in comparison to post and premenopausal status. The site of origin of the primary tumor does not appear to be a significant prognostic factor related to the same number of nodes involved. Direct correspondence exists between diameter of the primary tumor and metastatic regional nodes. In N- patients the evaluated prognostic factors are not significant; in N+ patients the cases with a significantly different risk of relapse were identified for N+ 1-3 by the perimenopausal status and for N+ greater than or equal to 4 by the diameter of tumor. Postoperative radiotherapy alone seems to be able to modify the prognosis of operable breast cancer. The combination of local radiotherapy and adjuvant medical therapy could be a logical approach not only in order to improve the local control but also to prevent metastases.     

Neuroblastoma of the olfactory nerve. Radiotherapy experiences in 6 patients

Six patients with neuroblastomas of the olfactory nerve (esthesioneuroblastoma) are presented who were irradiated between 1983 and 1986 at the Medical Radiologic Institute of Tübingen. Clinical manifestations, diagnostics, histology, therapy, and courses are compared and discussed with regard to a survey of literature. An attempt is made to find out the value of radiotherapy in the treatment of this rare disease. In stage A (tumor restricted to the nasal cavity, 1 patient), a local tumor control of up to now 28 months could be achieved by a treatment combination of surgery and radiotherapy. A treatment consisting of surgery or radiotherapy alone should even in this stage only be performed in connection with a close follow-up because of the increased local recurrence risk. Tumors of stage B (manifestation in the nasal cavity and the paranasal sinuses) did not occur in this group of patients. Five patients suffered from tumors of stage C (tumor extent beyond the paranasal sinuses). A good palliative effect was obtained temporarily by radiotherapy alone in three out of these patients showing large inoperable tumors and rapidly progressing clinical symptoms. A complete remission now lasting 16 months was achieved only in one patient by radical surgery with unilateral evisceration of orbit and homogeneous postirradiation. In case of stage C tumors it is recommended to perform, if possible, a radical tumor excision with evisceration of orbit in case of unilateral manifestation in the orbit and a postirradiation applying a radical, large volume technique. In order to reduce the risk of radiogenic cerebral necroses, it should be attempted to avoid dose maxima as they can occur when applying a combined ventro-dorsal and lateral irradiation technique.     

Clinical results of thermoradiotherapy for recurrent lung cancers--comparison of results with radiotherapy alone

From October 1986 through December 1989, 18 patients with locally recurrent lung cancer were treated by local hyperthermia combined with radiotherapy at the Kawasaki Medical School Hospital. Nine patients were initially treated by radiotherapy for inoperable lung cancer or as adjunct postoperative therapy. The other 9 were initially treated by chemotherapy or operation. Local heat was applied with a 13.56 MHz radiofrequency (RF) capacitive heating equipment, twice a week after radiotherapy, for 45-60 minutes per session. The results were compared with 17 patients with locally recurrent tumors which were treated by radiation therapy alone between January 1981 and September 1986. Tumor temperatures of two patients were measured directly by thermocouples inserted into the tumors which partially attached to the chest wall. As we were unable to measure tumor temperatures in the other 16 because of the anatomical difficulty, we measured the temperatures of the esophagus as near as possible to these lesions. Based on thermometry results, it was estimated that the maximum tumor temperatures were about 40-41 degrees C. The local response rates (CR + PR) were 25% in patients treated with combined therapy and 7% in those with RT alone. The median survivals after onset of retreatment were 10.7 months and 5.0 months, a statistically significant difference being demonstrated. Severe complications were not seen in this treatment.     

Adjuvante und neoadjuvante Therapie des Rektumkarzinoms

Background

The Consensus Conference of the German Cancer Society (CAO/AIO/ARO, 1. 7. 1998) has recently updated recommendations for patients with rectal cancer. Instead of a former reservation regarding the indication of adjuvant therapy for rectal cancer the actual version of the consensus particularly emphasizes the role of postoperative radiochemotherapy for stage-II/III tumors. This article reviews the most recent and ongoing trials of adjuvant and neoadjuvant therapy of rectal cancer.

Results

To avoid local recurrence is the most important aspect in the primary treatment of rectal cancer. In some series, e. g. the results of the Surgical Department of the University of Erlangen, a significant correlation between local control and survival was noted. The final results of the Swedish Rectal Cancer Trial with 1168 randomized patients not only confirmed the potential of radiotherapy to reduce local recurrence-rate, but also demonstrated a significant survival advantage for patients receiving short-course preoperative radiation therapy. Postoperative combination therapy is usual in the United States and in most European countries since the publication of two randomized trials of the Gastrointestinal Tumor Study Group (GITSG) and the North Central Cancer Treatment Group (NCCTG). The survival advantage resulting from an adjuvant radiotherapy with conventional doses and concurrent fluorouracil-based chemotherapy as compared to surgery alone was recently confirmed in a Norwegian trial. Protracted venous 5-fluorouracil infusion should further improve, treatment results. Numerous phase-II studies have demonstrated the efficacy of preoperative radiochemotherapy with high rates of pathological response. Thus, neoadjuvant radiochemotherapy is recommended for patients with locally advanced tumor primarily not amenable to curative surgery. Prospective randomized trials are ongoing to clarify the role of preoperative versus postoperative combined treatment for patients with resectable rectal cancer.

Conclusion

Radiochemotherapy for rectal cancer is recommended as standard treatment outside clinical trials for Stage II/III patients after curative treatment and for patients with T4-tumor prior to surgery. The optimal use of chemotherapy and the sequence of treatment modalities remains to be elucidated.     

Die Behandlung des zentralen Neurozytoms: eine Metaanalyse basierend auf den Daten von 358 Patienten

BACKGROUND: Central neurocytomas are described as uncommon benign CNS lesions. Uncertainty exists about the most appropriate treatment regimen. This retrospective analysis compares four therapies for local control and overall survival: complete resection alone (KR), complete resection plus radiotherapy (KR-RT), incomplete resection alone (IR), and incomplete resection plus radiotherapy (ITR-RT). MATERIAL AND METHODS: The cases published in the literature since 1982 were reviewed for age, gender, extent of resection, atypical neurocytoma, radiotherapy, local control, and overall survival (minimum follow-up 12 months). From direct contact with the authors additional data were obtained providing more detailed information about the patients and a longer follow-up. Statistical analysis was performed with the Kaplan-Meier analysis and the log-rank test. RESULTS: Complete data were obtained from 358 patients (KR 118, KR-RT 35, IR 91, IR-RT 114). Local control was significantly better after KR, KR-RT and IR-RT than after IR (Figure 1). No significant difference was found between KR, KR-RT and IR-RT. Median time to progression was 36 (KR), 39 (KR-RT), 21 (IR) and 32 (IR-RT) months. The comparison of the four groups for overall survival demonstrated that KR provided a significantly better overall survival than IR (Figure 2). Overall survival rates were 99.2% and 86.1%, respectively. CONCLUSIONS: Complete resection is much more effective for the treatment of central neurocytoma than incomplete resection. After complete resection the additional benefit of postoperative radiotherapy remains unclear. After incomplete resection postoperative radiotherapy significantly improved local control, but not overall survival.     

^125I粒子组织间植入联合外照射治疗小鼠Lewis肺癌的实验研究

目的探讨^125I粒子组织间植入联合外照射治疗肺癌的有效性。方法建立C57BL／6小鼠Lewis肺癌（LLC）实体瘤模型后,按完全随机化法分为对照组、单纯^125I粒子组织间植入内放疗组、单纯外放疗组（15Gy）、^125I粒子组织问植入联合外放疗（^125I＋外放疗8Gy）组,每组6只小鼠。分组处理后每3天测量肿瘤体积,15d后处死小鼠并测肿瘤质量,计算抑瘤率,制作肿瘤组织标本,行常规病理学检查,以免疫组织化学法检测肿瘤微血管密度（MVD）的表达。利用单因素方差分析比较组间差异,行SNK法q检验。结果与对照组比较,单纯内放疗组、单纯外放疗组（15Gy）及联合放疗组（^125I粒子＋外放疗8Gy）LLC体积均有不同程度的生长抑制（q=11．06,17．13,16．31,P均〈0．05）,单纯外放疗组与联合放疗组最明显（抑瘤率分别为50．9％、48．4％）,虽目前两者瘤质量差异无统计学意义（q=0．50,P〉0．05）,但联合放疗组抑瘤率高于单纯内放疗组（48．4％与28．6％）。免疫组织化学结果显示4组小鼠肿瘤MVD值分别为（23．33±4．84）、（17．50±3．67）、（11．83±2．14）、（12．67±3．39）个微血管／高倍视野（×200）,单纯内放疗组的MVD值低于对照组,且高于联合放疗组,差异有统计学意义（q=3．92和3．25,P均〈0．05）,而联合放疗组与单纯外放疗组间的差异无统计学意义（q=0．57,P〉0．05）。结论放疗可通过降低肿瘤MVD值,减少血管生成而抑制肿瘤生长。在达到相同的肿瘤局部控制率的情况下,联合^125I粒子组织间植入照射可有效减少外照射剂量,使周围正常组织器官的吸收剂量减低。     

Cancer of the piriform sinus: treatment by radiation therapy alone and with surgery

To ascertain the optimal treatment for carcinoma of the piriform sinus, the authors determined survival rates and local and regional tumor growth for two groups of patients: those treated by radiation therapy alone (n = 209) and those treated by radiation therapy combined with surgery (n = 154). The two groups were similar with respect to the characteristics of primary tumor stage and degree of nodal involvement. The overall 3-year and 5-year actuarial survival rates were 19.2% and 15.5%, respectively. For 5-year actuarial survival, there was no significant difference between patients with T1 and T2 tumors, but there was a significant difference between patients with T1 + T2 tumors versus those with T3 tumor. There was no significant difference in 3- and 5-year survival between patients with N0 and N1 nodal involvement and those with N1 and N2 involvement, but there was a significant difference between patients with N0 versus those with N3 involvement. The 5-year actuarial survival rate is significantly better for patients who underwent surgery followed by radiation therapy than for those who received only radiation therapy. However, for patients with early-stage (T1 and T2) tumors, radiation therapy alone controls local tumor growth as well as the combination of surgery and radiation therapy does. For each treatment group, the causes of death and patterns of failure were studied and compared with investigations to date.     

Strahlentherapie nach radikaler Prostatektomie

Background

Radiation therapy following radical prostatectomy in locally progressed prostate carcinoma has become increasingly important in the last few years as both adjuvant therapy in patients with pT3-tumors with or without positive margins and treatment for a PSA increase in local recurrence of disease. The background for this is the knowledge gained by using PSA that up to 60% of the patients with histopathologically confirmed pT3/4 tumors or involvement of the lymph nodes are systemically and/or locally progressive after 3 to 5 years if only surgical or radiation therapy was performed.

Results

A number of studies, albeit exclusively retrospective, substantiated a significantly high local tumor control by radiotherapy after radical prostatectomy. This holds true for adjuvant therapy with a PSA in the “zero range” as well as with a PSA increase from the “zero range”, whereby it must be taken into consideration that a certain percentage of treated patients with a PSA in the “zero-range” with or without positive margins actually do not need further therapy. Two retrospective studies demonstrated a significant better lengthening of “freedom from treatment failure” that is local and systemic progression of disease. Lengthening the survival time has, however, not yet been proven. With an increase in the PSA from the “zero range” after radical prostatectomy, there are indications that systemic metastatic spread already occurs with values higher than 2.5 to 4 ng/ml and the radiotherapy no longer has any curative intention.

conclusions

Adjuvant RT following radical prostatectomy gives better local control rates and probably better rates of “freedom from treatment failure” in patients with locally advanced prostate cancer with positive margins and probably in patients with negative margins. However, in retrospective studies no advantage in overall survival was shown.     

Results from 215 patients with laryngeal carcinoma treated with sole radiotherapy or with a combination of radiotherapy and operation (author's transl)]

Results of radiotherapy alone or in combination with surgery in 215 patients with laryngeal cancer are reported (treatment time between 1963 and 1976). In patients with glottic cancer, the cure rate is about 80% and surgical treatment for persistent/recurrent cancer was necessary only in a few cases. Analysis of tumor dose, tumor control rate and complication rate shows that in cases with glottic cancer a tumor dose between 1900 and 2000 ret is necessary and tolerable. In patients with supraglottic laryngeal cancer, the cure rate is about 55%. Early stages (T1N0M0) were mostly treated by radiotherapy alone, moderately advanced stages (T1N1,T2N0+1) mostly received radiotherapy as a primary treatment and were operated in case of irradiation failure. Advanced stages were primarily treated by a combined therapy, and by radiotherapy alone if they were inoperable. In early cases, who are to be treated by radiotherapy alone, the tumor dose should be about 1900 ret. In moderate cases, treatment by primary irradiation alone is possible, if the patient can be followed up regularly; surgery is indicated, if the patient cannot unequivocally be classified as symptomless. In some of these cases, there is no tumor demonstrable histologically in the excised larynx. In using this treatment policy, there is a better functional treatment result than in using primary combined treatment in moderately advanced cases with supraglottic laryngeal cancer.     

Hepatocellular carcinomas 2-3 cm in diameter: transarterial chemoembolization plus radiofrequency ablation vs. radiofrequency ablation alone

Objective

There is debate whether transarterial chemoembolization (TACE) plus radiofrequency ablation (RFA) is more effective than RFA alone in the treatment of patients with small hepatocellular carcinoma (HCC). We therefore retrospectively compared these treatments in patients with HCCs of diameter 2–3 cm.

Materials and methods

Outcomes, including tumor progression, survival rates, and major complications, were compared in 83 patients (83 tumors) treated with combined TACE and RFA and in 231 patients (231 tumors) treated with RFA alone.

Results

Median follow-up periods were similar in the TACE + RFA and RFA alone groups (37 vs. 38 months). During follow-up, local tumor progression was observed in 16% and 41% of tumors, respectively. The 1, 3, and 5 year local tumor progression-free survival rates were significantly higher in the TACE + RFA group (95%, 86%, and 83%, respectively) than in the RFA-alone group (78%, 61%, and 53%, respectively; P < 0.001). The 1, 3, and 5 year overall survival rates, however, were similar in the TACE + RFA (93%, 72%, and 63%, respectively) and RFA (93%, 73%, and 53%, respectively) groups (P = 0.545), as were the rates of major complications (1.2% vs. 0.4%).

Conclusions

Combined TACE and RFA was safe and provided better local tumor control than RFA alone in the treatment of 2- to 3-cm sized HCCs, although survival rates were similar.