AJR:210, April 2018 891 Transcatheter arterial chemoembolization (TACE) of the hepatic artery is considered the standard treatment of patients with BCLC-B HCC. However, patients with BCLC-B HCC are a highly heterogeneous population, and it remains unclear whether there is a subgroup of BCLC-B HCC for which TACE can provide a better prognosis [6]. Recently, curative therapy in the form of TACE combined with radiofrequency abla- tion (RFA), hereafter referred to as “TACE- RFA,” has been reported to yield better over- all survival than TACE alone in patients with BCLC-B HCC [7–15]. Previous reports and guidelines have suggested that TACE-RFA could provide therapeutic beneft for BCLC- B HCC because TACE-RFA has been shown to be more effective at increasing the size of the ablated area [16]. However, it remains un- settled whether TACE-RFA actually im- proves the prognosis. Transcatheter Arterial Chemoembolization With or Without Radiofrequency Ablation: Outcomes in Patients With Barcelona Clinic Liver Cancer Stage B Hepatocellular Carcinoma Masashi Hirooka 1 Atsushi Hiraoka 2 Hironori Ochi 3 Yoshiyasu Kisaka 4 Kouji Joko 3 Kojiro Michitaka 2 Yoichi Hiasa 1 Hirooka M, Hiraoka A, Ochi H, et al. 1 Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa 454, Toon, Ehime 791-0295, Japan. Address correspon- dence to Y. Hiasa (hiasa@m.ehime-u.ac.jp). 2 Gastroenterology Center, Ehime Prefectural Central Hospital, Ehime, Japan. 3 Center for Liver-Biliary-Pancreatic Diseases, Matsuyama Red Cross Hospital, Ehime, Japan. 4 Department of Gastroenterology, Uwajima City Hospital, Ehime, Japan. Vascular and Interventional Radiology • Original Research AJR 2018; 210:891–898 0361–803X/18/2104–891 © American Roentgen Ray Society H epatocellular carcinoma (HCC) is the ffth most common cancer worldwide. Several staging sys- tems have been reported for stratifying patients with HCC into subgroups [1–5]. Of these staging systems, the Barcelo- na Clinic Liver Cancer (BCLC) classifcation is the most widely used to predict prognoses and determine treatment modalities [6]. Ac- cording to the BCLC staging system, HCC is stratifed into very early (stage 0), early (stage A), intermediate (stage B [hereafter referred to as “BCLC-B”]), advanced (stage C), and end (stage D) stages. Guidelines from the Eu- ropean Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD) con- sider patients with stage 0 HCC and stage A HCC suitable for curative treatment, whereas patients with stage B HCC and stage C HCC are suitable only for palliative treatment [6]. Keywords: hepatocellular carcinoma, intermediate-stage hepatocellular carcinoma, radiofrequency ablation, transcatheter arterial chemoembolization (TACE) doi.org/10.2214/AJR.17.18177 Received March 3, 2017; accepted after revision August 23, 2017. Based on a presentation at the American Association for the Study of Liver Diseases 2016 annual meeting, Boston, MA. This work was supported in part by Japan Society for the Promotion of Science (JSPS) Kahenhi grant number 15K09960 to M. Hirooka and JSPS Kakenhi grant number 15K09006 to Y. Hiasa. OBJECTIVE. The objective of our study was to clarify the indications for transcatheter arterial chemoembolization (TACE) of the hepatic artery combined with radiofrequency ab- lation (RFA), which we refer to as “TACE-RFA,” for patients with hepatocellular carcinoma (HCC) beyond the Milan criteria. This study assessed the prognoses of patients with inter- mediate-stage HCC, which we defned as Barcelona Clinic Liver Cancer (BCLC) stage B (hereafter referred to as BCLC-B), according to the BCLC-B substages through treatment in a multicenter study. MATERIALS AND METHODS. Two-hundred thirty patients with intermediate-stage HCC who were treated from January 2000 to December 2015 were enrolled. These patients were divided into four classes (B1–B4) according to the Bolondi classifcation. Between these substages, the prognosis of patients who underwent TACE-RFA was compared with that of patients who underwent TACE, the latter of which is the suggested standard therapy for pa- tients with BCLC-B HCC. RESULTS. TACE-RFA and hepatic resection survival curves were better than those of TACE ( p < 0.001 for TACE-RFA vs TACE). In particular, for substages B1 and B2, the over - all survival rates of patients who underwent TACE-RFA were signifcantly higher than those who underwent TACE (B1, p < 0.001 for TACE-RFA vs TACE; B2, p = 0.015 for TACE-RFA vs TACE). CONCLUSION. The indications for TACE-RFA may be expanding to BCLC-B HCC. For patients with disease classifed as substages B1 and B2, TACE-RFA may be a better treat- ment modality than TACE alone. Hirooka et al. TACE Versus TACE-RFA of HCC Vascular and Interventional Radiology Original Research Downloaded from www.ajronline.org by 44.200.189.126 on 12/04/21 from IP address 44.200.189.126. Copyright ARRS. For personal use only; all rights reserved