Efficacy of transarterial chemoembolization compared with radiofrequency ablation for the treatment of recurrent hepatocellular carcinoma after radiofrequency ablation

Purpose: To compare the efficacy and outcome of transarterial chemoembolization (TACE) with radiofrequency ablation (RFA) in the treatment of recurrent hepatocellular carcinoma (HCC) after initial RFA. Material and methods: From January 2008 to December 2014, 199 consecutive patients with primary HCC underwent percutaneous RFA as initial treatment. One hundred and fourteen patients developed intrahepatic recurrent HCC after initial RFA. The patients with recurrent tumor size <= 3 cm and tumor numbers <= 3 who underwent RFA (n = 47) or TACE (n = 31) were included in study. Progression-free survival (PFS), tumor response to treatment and overall survival (OS) were assessed. Prognostic factors for OS were analyzed using multivariate Cox proportional hazard models. Results: The baseline data of initial HCC and the first recurrence of HCC were comparable in both groups. The complete response (CR) rate in the RFA group and the TACE group was 95.7% and 50%, respectively (p < .001). The PFS time in the RFA group and the TACE group was 424 days and 275 days, respectively (p = .004). The one-year and three-year cumulative overall survival rate was 93.5% and 45% in the TACE group, 91.3% and 68.8% in the RFA group (p = .49), respectively. Significant predictive factors for OS were tumor size (HR = 1.951, 95%CI 1.061-3.687, p = .032), prothrombin time (HR = 1.59, 95%CI 1.012-2.498, p = .044) and response to treatment (HR = 0.267, 95%CI 0.092-0.78, p = .016). Conclusion: Repeated RFA is still considered to be the first treatment choice for patients with post-RFA intrahepatic recurrence. However, TACE should also be considered due to comparable overall survival benefits. The advantages of being less invasive and highly repeatable may render TACE to be a preferred treatment for some patients with recurrent HCC after RFA.