Survival analysis of high intensity focused ultrasound ablation versus transarterial chemoembolisation for unresectable hepatocellular carcinoma larger than 3cm

Abstract

INTRODUCTION: Treatment for hepatocellular carcinoma (HCC) in the present of liver cirrhosis is always difficult. The 2 year survival of TACE is less than 30%. High-intensity focused ultrasound (HIFU) ablation is a non-invasive treatment for HCC but long term survival data is lacking for large HCC. In this study we aim to analysis the outcome for patients receiving this treatment compared to TACE. Patients and Method: From Oct 2003 to Sept 2010, 2431 patients were diagnosed HCC. Total 112 patients received HIFU treatment. 27 patients has HCC larger than 3cm. 54 patient with matched tumour characteristic receiving TACE as primary treatment were selected for comparison. RESULTS: There were twenty six patients received HIFU therapy during the study period. Total Forty six tumours were ablated by this treatment entity. The median age for the patients was 69 (range 49 years–84 years). The median tumour size was 4.2cm (range 3–8cm). Fifty-two patients received TACE for HCC during this period. According to RECIST criteria, 50.0% patients had complete tumour response, 7.7% patients had partial tumour response, 34.6% patients had stable disease and 7.7% patients had progressive disease in the HIFU group. In the TACE group, none of the patient had complete tumour response, 21.2% patients had partial tumour response, 63.5% patients had stable disease and 15.4% patients had progressive disease. (p < 0.0001) In the HIFU group, the one year survival was 84.6%, the three year survival was 49.2% and the five year survival was 32.3%. In the TACE group, the one year survival was 69.2% the three year survival was 29.8% and the five year survival was 2.3%. (p = 0.001) CONCLUSION: High intensity focused ultrasound ablation is a safe and effective method for unresectable HCC. The survival benefit is observed over TACE alone in selected patient.