A Prospective Randomized Trial Comparing Cytoreductive Surgery Followed by Transcatheter Arterial Chemoembolization (TACE) Versus TACE Alone for Multinodular Hepatocellular Carcinoma (MNHCC)
Hepatocellular carcinoma (HCC) is one of the world's most common malignancies, especially in
East-Asian countries. Hepatic resection has been accepted as the only means of cure for
patients with HCC. The results of hepatic resection for early-stage HCC are
favorable.Nevertheless, the role of surgical resection for multinodular HCC (MNHCC) is less
well-defined.The presence of multiple tumors has been shown to be one of the most
significant independent factors to influence cumulative survival rates in HCC after hepatic
resection.Using the BCLC criteria,liver transplantation provides an alternative curative
treatment option for MNHCC with size ≤ 5 cm in diameter and tumor number <3,but MNHCC beyond
these criteria usually receive palliative therapy.
For MNHCC which not suitable for curative treatment, non-surgical and surgical interventions
are available for palliative care.Cytoreductive surgery has the potential to increase the
quality and quantity of survival in patients with advanced HCC. Cytoreductive surgery is
carried out with partial hepatectomy,cryosurgery,microwave coagulation therapy(MCT),or
absolute alcohol injection.It has been shown to prolong survival and provide good
symptomatic relief in patients with good surgical risks in non-randomized
studies.Cytoreductive surgery aims at removal or destruction of all macroscopic tumours,
allowing microscopic foci to persist while preserving as much of the functional liver tissue
as possible. The development of effective local ablative therapy (LAT), such as
radiofrequency ablation (RFA) therapy, facilitates reduction of the tumour burden even
further during the operation.Cytoreductive surgery can also be followed by other
non-surgical treatments,such as regional therapy or systemic therapy, to deal with the
residual disease or micrometastases.
The aim of this study is to compare the surgical outcomes of cytoreductive surgery followed
by TACE with TACE alone in patients with MNHCC so as to establish a treatment standard for
MNHCC.
Interventional
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
the overall survival rate of each group
3 years
No
Weiping Zhou, M.D.
Study Chair
Eastern Hepatobiliary Surgery Hospital, Second Military Medical University
China: Ministry of Health
EHBH-RCT-2008-021
NCT00820157
November 2008
December 2012
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