Mass Reduction by Radiofrequency Ablation Before Hepatic Arterial Infusion Chemotherapy Improved Prognosis for Patients With Huge Hepatocellular Carcinoma and Portal Vein Thrombus

OBJECTIVE. The prognosis for patients with advanced large hepatocellular carcinoma (HCC) with portal vein (PV) tumor thrombosis remains poor, and treatment is usually limited to hepatic arterial infusion (HAI) chemotherapy. In this study, we first performed mass reduction using radiofrequency ablation (RFA), followed by HAI chemotherapy. Prognosis after this treatment was evaluated. SUBJECTS AND METHODS. HCC with PV tumor thrombosis was diagnosed in 20 patients between April 2004 and December 2008, and treatment was performed using mass-reduction therapy by RFA before HAI chemotherapy. For comparison, 33 patients treated with HAI chemotherapy without RFA were retrospectively selected as historical control subjects under the same conditions. Prognosis in each group was evaluated. RESULTS. Mass-reduction therapy by RFA combined with HAI chemotherapy achieved complete response in six patients (30%), partial response in 11 patients (55%), stable disease in two patients (10%), and progressive disease in one patient (5%). Among the control subjects, complete response was seen in 0 patients (0%), partial response in 12 patients (33.3%), stable disease in 16 patients (44.4%), and progressive disease in eight patients (22.2%). The cumulative survival rates for those who received the combined therapy at 6, 12, and 24 months were 100%, 89.7%, and 78.8%, respectively. The median survival was 953 days (95% CI, 760-1.102 days). In the control subjects, the cumulative survival rates at 6, 12, and 24 months were 84.9%, 56.1%, and 16.9%, respectively (p < 0.0001). No serious adverse events were encountered in either group. CONCLUSION. For patients with huge HCC and PV tumor thrombosis, mass-reduction treatment by RFA before HAI chemotherapy is safe and can improve prognosis.