(April 8, 2008 - Insidermedicine) Combining specialized chemotherapy with radiofrequency thermal ablation (RFA) is more effective than either therapy used alone in patients with nonresectable, advanced hepatocellular carcinoma, according to research in the Journal of the American Medical Association.

Here are some recommendations for the treatment of hepatocellular carcinoma from American Association for the Study of Liver Diseases:

•    Patients who have a single lesion can be offered surgical resection if they are non-cirrhotic or have cirrhosis but still have well preserved liver function, normal bilirubin, and a hepatic vein pressure gradient <10 mmHg

•    Liver transplantation is an effective option for patients with hepatocellular carcinoma corresponding to the Milan criteria: solitary tumor <5 cm or up to three nodules <3 cm.

•    Local ablation is safe and effective therapy for patients who cannot undergo resection or as a bridge to transplantation, while transcatheter arterial chemoembolization (TACE) is recommended as first line non-curative therapy for non-surgical patients with large/multifocal hepatocellular carcinoma who do not have vascular invasion or extrahepatic spread.

Researchers out of Shandong University in China randomized 291 patients with hepatic tumors larger than 3 cm to treatment with TACE alone, RFA alone, or both TACE and RFA combined.

At follow-up, 84% of patients receiving TACE or RFA had died, compared with only 69% in the combined treatment group. The lower mortality rate in the TACE-RFA group could be attributed to fewer deaths resulting from tumor progression. Median survival was 24 months with TACE, 22 months with RFA, and 37 months with combined therapy.

While the role of TACE + RFA remains controversial, today’s research highlights the potential benefits of this combination therapy for improving long-term survival rates among patients with advanced, nonresectable hepatocellular carcinoma.

For Insidermedicine in Depth, I'm Dr. Susan Sharma.