Laser ablation is superior to TACE in large-sized hepatocellular carcinoma: A pilot case-control study

Morisco, Filomena; Camera, Silvia; Guarino, Maria; Tortora, Raffaella; Cossiga, Valentina; Vitiello, Anna; Cordone, Gabriella; Caporaso, Nicola; Di Costanzo, Giovan Giuseppe; Zoli, M.; Garuti, F.; Neri, A.; Piscaglia, F.; Lenzi, B.; Valente, M.; Trevisani, F.; Bolondi, L.; Biselli, M.; Caraceni, P.; Cucchetti, A.; Domenicali, M.; Gramenzi, A.; Magalotti, D.; Serra, C.; Venerandi, L.; Cappelli, A.; Golfieri, R.; Mosconi, C.; Renzulli, M.; Giannini, E. G.; Brunacci, M.; Moscatelli, A.; Pellegatta, G.; Savarino, V.; Caturelli, E.; Roselli, P.; Lauria, V.; Pelecca, G.; Dell'Isola, S.; Ialungo, A. M.; Rastrelli, E.; Cabibbo, G.; Cammà, C.; Attardo, S.; Rossi, M.; Cavani, G.; Virdone, R.; Affronti, A.; Nardone, G.; Felder, M.; Mega, A.; Ciccarese, F.; Del Poggio, P.; Olmi, S.; Foschi, F. G.; Bevilacqua, V.; Dall'Aglio, A. C.; Ercolani, G.; Fiorini, E.; Casadei Gardini, A.; Lanzi, A.; Mirici Cappa, F.; Sacco, R.; Mismas, V.; Svegliati Barone, G.; Schiadà, L.; Farinati, F.; Gazzola, A.; Murer, F.; Pozzan, C.; Vanin, V.; Rapaccini, G. L.; de Matthaeis, N.; Gasbarrini, A.; Rinninella, E.; Olivani, A.; Missale, G.; Biasini, E.; Di Marco, M.; Balsamo, C.; Vavassori, E.; Masotto, A.; Marchetti, F.; Valerio, M.; Marra, F.; Aburas, S.; Campani, C.; Dragoni, G.; Borzio, F.; Benvegnù, L.; Festi, D.; Marasco, Giovanni; Ravaioli, Federico

doi:10.18632/oncotarget.24756

Background:Limited therapies are available for large (≥40 mm) unresectable hepatocellular carcinoma (HCC). Currently, the standard treatment with transarterial chemoembolisation (TACE) is unsatisfactory with high recurrence rate and limited effect on survival. Laser Ablation (LA) has emerged as a relatively new technique characterized by high efficacy and good safety. This study is aimed to evaluate the efficacy of LA in comparison to TACE in patients with large HCC. Methods: Eighty-two patients with a single HCC nodule ≥40 mm (BCLC stage A or B) were enrolled in this case-control study. Forty-one patients were treated with LA and 41 patients were treated with TACE. Response to therapy was evaluated according to the mRECIST criteria. Survival was calculated with Kaplan-Meier from the time of cancer diagnosis to death with values censored at the date of the last follow-up. Results: Twenty-six (63.4%) and 8 (19.5%) patients had a complete response after LA and TACE, respectively (p < 0.001). Subsequently we stratified the HCCs in 3 categories according to the nodule size: 40-50 mm, 51-60 mm, and > 60 mm. LA resulted superior to TACE especially in nodules ranging between 51 and 60 mm in diameter, with a complete response rate post-LA and post-TACE of 75% and 14.3%, respectively (p = 0.0133). The 36 months cumulative survival rate in patients treated with LA and TACE was 55.4% and 48.8%, respectively. The disease recurrence rates after LA and TACE were 19.5% and 75.0%, respectively. Conclusions: LA is a more effective therapeutic option than TACE in patients with solitary large HCC.