Association of Addition of Ablative Therapy Following Transarterial Chemoembolization With Survival Rates in Patients With Hepatocellular Carcinoma

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Abstract
Hepatocellular carcinoma (HCC) is the most common primary liver cancer and is the fourth leading cause of cancer-related death worldwide, accounting for more than 782 000 total deaths in 2018.1 Transarterial chemoembolization (TACE) has been shown to improve the survival of patients with HCC compared with best supportive care in randomized clinical trials and meta-analyses conducted over the last 20 years. For example, a 2002 randomized trial2 found a survival advantage of conventional TACE when added to best supportive care (TACE, 28.6 months vs best supportive care, 17.9 months; P = .01). However, TACE as a solitary treatment rarely produces a complete response. Current consensus guidelines recommend TACE or systemic therapy for patients with either poor performance status, advanced liver cancer, or poor liver function.3 The addition of radio frequency ablation (RFA) to TACE likely improves survival in subsets of patients with HCC and should be considered as part of the treatment paradigm for these patients.4-8 Whether the addition of other ablative therapies to TACE such as microwave ablation (MWA) or stereotactic body radiation therapy (SBRT) can improve outcomes, including overall survival (OS), is not fully elucidated. Previously published data suggest that SBRT may be associated with a progression-free survival benefit, particularly among patients with a lesser disease burden.9

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