27 mei 2012: link naar volledig studieverslag toegevoegd en review studie toegevoegd..

31 augustus 2008: Bron: 1: JAMA. 2008 Apr 9;299(14):1669-77.

Het lijkt me duidelijk dat deze studie ook toegevoegd kan worden in de aanvraag voor vergoeding van de behandeling met TACE en LITT. Al geldtdit alleen voor primaire levertumoren. Klik hier voor het volledige studieverslag van onderstaand abstract.

Onderaan hebben we een meta analyse toegevoegd uit 2011 van TACE - Trans Arteriële Chemo Embolisatie en Radio Frequency Ablation - RFA bij primaire leverkanker

Ook deze gerandomiseerde studie bewijst namelijk dat wanneer TACE - Transarteriele Chemo Embolisatie wordt gecombineerd met RFA - Radio Frequency Ablation in he behandelen van kankerpatienten met levertumoren groter dan 3 cm. de overall overleving significant beter wordt dan wanneer alleen RFA of TACE wordt toegepast. De mediane overleving ging omhoog van 24 maanden in de TACE groep (3.4 courses), 22 maanden in de RFA groep (3.6 courses), naar 37 maanden in de TACE-RFA groep (4.4 courses). Patienten behandeld met TACE-RFA hadden betere kans op overall overleving dan de patienten behandeld met TACE alleen (hazard ratio , 1.87; 95% confidence interval , 1.33-2.63; P < .001) or RFA (HR, 1.88; 95% CI, 1.34-2.65; P < .001)

Chemoembolization combined with radiofrequency ablation for patients with hepatocellular carcinoma larger than 3 cm: a randomized controlled trial.

Bron: 1: JAMA. 2008 Apr 9;299(14):1669-77. Links

Cheng BQ, Jia CQ, Liu CT, Fan W, Wang QL, Zhang ZL, Yi CH.

Department of Gastroenterology, Qilu Hospital School of Medicine, Jinan, China. dcbq@sohu.com

CONTEXT: Transarterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) therapy has been used for patients with large hepatocellular carcinoma tumors, but the survival benefits of combined treatment are not known.

OBJECTIVE: To compare rates of survival of patients with large hepatocellular carcinoma tumors who received treatment with TACE combined with RFA therapy (TACE-RFA), TACE alone, and RFA alone.

DESIGN, SETTING, AND PATIENTS: Randomized controlled trial conducted from January 2001 to May 2004 among 291 consecutive patients with hepatocellular carcinoma larger than 3 cm at a single center in China.

INTERVENTION: Patients were randomly assigned to treatment with combined TACE-RFA (n = 96), TACE alone (n = 95), or RFA alone (n = 100). MAIN OUTCOME MEASURES: The primary end point was survival and the secondary end point was objective response rate.

RESULTS: During a median 28.5 months of follow-up, median survival times were 24 months in the TACE group (3.4 courses), 22 months in the RFA group (3.6 courses), and 37 months in the TACE-RFA group (4.4 courses). Patients treated with TACE-RFA had better overall survival than those treated with TACE alone (hazard ratio , 1.87; 95% confidence interval , 1.33-2.63; P < .001) or RFA (HR, 1.88; 95% CI, 1.34-2.65; P < .001). In a preplanned substratification analysis, survival was also better in the TACE-RFA group than in the RFA group for patients with uninodular hepatocellular carcinoma (HR, 2.50; 95% CI, 1.42-4.42; P = .001) and in the TACE-RFA group than the TACE group for patients with multinodular hepatocellular carcinoma (HR, 1.99; 95% CI, 1.31-3.00; P < .001). The rate of objective response sustained for at least 6 months was higher in the TACE-RFA group (54%) than with either TACE (35%; rate difference, 0.19; 95% CI, 0.06-0.33; P = .009) or RFA (36%; rate difference, 0.18; 95% CI, 0.05-0.32; P = .01) treatment alone.

CONCLUSION: In this patient group, TACE-RFA was superior to TACE alone or RFA alone in improving survival for patients with hepatocellular carcinoma larger than 3 cm. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00479050.

PMID: 18398079 [PubMed - indexed for MEDLINE]

An overview of evidence-based management of hepatocellular carcinoma: a meta-analysis

Bron: Het volledige studie verslag van onderstaand abstract kunt u hier gratis inzien.

J Cancer Res Ther. 2011 Oct-Dec;7(4):463-75.

An overview of evidence-based management of hepatocellular carcinoma: a meta-analysis.

Salhab M, Canelo R.

Source

Department of Surgery and Cancer, HPB and Surgery Unit, Imperial College Healthcare NHS Trust London, United Kingdom. drsalhab@hotmail.co.uk

Abstract

INTRODUCTION:

An increasing trend of incidence in hepatocellular carcinoma (HCC) has been recorded in most developed countries. HCC ranks among the ten most common cancers worldwide. The health costs and burden to the economy implicated by HCC are huge. In recent years, the surveillance programs and screening for the disease, in addition to increasing awareness, led to the detection of smaller precursor lesions of HCC in the liver. The rise of molecular-targeted therapies and the publication of various conflicting guidelines on the management of the disease demand a review of evidence into the curative therapies and medical management of HCC.

AIMS:

The primary objective was to identify the survival benefit of the primary medical modalities in HCC, as more trials were uncovered between 2005 and 2010. The secondary objective was to conduct a meta-analysis. Selection criteria were implemented to select randomized controlled trials (RCTs), to include in this study. After selection, all the articles were ranked according to their strength.

MATERIALS AND METHODS:

The MEDLINE, CANCERLIT, Embase databases, and the Cochrane Library were reviewed using the national library of health website. The time limit used for searching for RCTs was between January 2005 and December 2010. Overall survival and the cumulative probability of no recurrence were the primary endpoints considered in the studies to be assessed. These endpoints were measured over one, two, or three years, depending on the size of the study and the length of follow-up. The software package comprehensive meta-analysis ver 2.0.exe (Biostat, USA) was used to comply with the results, to conduct the meta-analysis, and help with analyzing the data.

RESULTS:

The original general search yielded 193 RCTs between 2005 and 2010. Only 32 studies met the inclusion criteria. However, after the ranking of the studies according to strength, only 17 studies were eventually selected. The 17 studies were subsequently classified according to the following; surgical resection (n = 2); percutaneous treatments (n = 5); chemoembolization (n = 1); systemic treatments (n = 8); and other treatments (n = 1). Randomized studies comparing the percutaneous ethanol injection (PEI) to the surgical resection were inconclusive. However, percutaneous treatments showed results similar to surgical resection in terms of overall survival. The meta-analysis comparing PEI to radiofrequency ablation (RFA) showed RFA to be superior to PEI in terms of overall survival at three years (odds ratio 1.698; 95% CI 1.206 - 2.391; P = 0.002). When adverse events were considered there was no statistically significant difference between the RFA and PEI groups (odds ratio 1.199; 95% CI 0.571- 2.521; P = 0.632).

CONCLUSION:

RFA should be the first-line treatment in patients with a single small HCC tumor ≤ 3 cm. Careful patient selection is crucial prior to transarterial chemoembolization (TACE), as the procedure may be associated with an increased risk of liver failure. Tamoxifen has no role to play in the treatment of HCC. Sorafenib should be the first-line treatment in patients with advanced and inoperable HCC. The role of Sorafenib in the management of early stage HCC remains to be determined.