Transcatheter Arterial Chemoembolisation Combined Radiofrequency Ablation For Hepatocellular Carcinoma: A Systematic Review Of Randomised And Non-randomised Controlled Trials

Background: Hepatocellular carcinoma is one of the most common malignant diseases worldwide. A potential curative option is surgical resection. Due to impaired liver function and/or anatomical reasons only few patients can be treated surgically. For the majority of patients, several interventions have been developed. Among these, transcatheter arterial chamoembolisation has been widely used as primary threapy for inoperable HCC. While in all the six initial randomised controlled trials of chemoembolisation as primary treatment for HCC none show any increase in survival, although tumour shrinkage was seen. All of these trials included patients with predominantly large tumours and severe underlying liver diseases. And since then, a combined therapy of TACE and other treatments was developed for patients with inoperable large HCC. When radiofrequency was used clinically for tumour ablation, a dramatic effect was found if it sequentially followed the treatment of TACE. The advantage of this combined therapy of TACE and RFA has been demonstrated by more and more following clinical studies.Objective: To evaluate the effects and safety of combination therapy of TACE and RFA for patients with HCC respect to clinically relevant outcomes versus all other interventions or no intervention.