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The current standard treatment for intermediate-stage HCC (BCLC stage B) is transcatheter arterial chemoembolization (TACE) alone. The combination of TACE with RFA has also reported to be an effective treatment for HCC. Some prospective studies have shown that TACE combined with RFA have better efficacy than any of them alone for early stage HCC (single tumor ≤5 cm). However, to the investigators' knowledge, there have not been any prospective studies to assess whether TACE combined sequentially with RFA is more effective than TACE alone for the treatment of intermediate-stage HCC. The investigators hypothesized that the combination of TACE and RFA might result in better patient survival than TACE alone. Thus, the purpose of this study was to prospectively compare the effects of sequential TACE-RFA with TACE alone for the treatment of intermediate-stage HCC. Intermediate-stage HCC in this study was defined as 2-3 intrahepatic lessions, largest tumor size 3-7 cm or 4-10 intrahepatic lessions, largest tumor size ≤7 cm; ECOG-PS 0; Child-pugh A or B7; no tumor thrombus or extrahepatic metastases.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| TACE-RFA | Experimental | RFA follows TACE when achieving ablation eligibility criteria defined in this study, with no more than four sessions of TACE. |
|
| TACE alone | Active Comparator | On-demand TACE. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| TACE | Procedure | A catheter (or a microcatheter for cases where small vessels and branches cannot be accessed with a standard angiographic catheter) will be advanced selectively or superselectively into the right or left hepatic artery or the feeding arteries directly supplying the tumor. Depending on tumor size, location, blood supply, and liver function, the interventional radiologist administers a cytotoxic agent and lipiodol emulsion (30 mg lobaplatin, 30 mg pirarubicin, and < 15 mL lipiodol) through the catheter. Following drug infusion, embolization of the tumor vessels will be routinely performed using gelatin sponge particles. |
| Measure | Description | Time Frame |
|---|---|---|
| Progression-free survival (PFS) according to Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 (PFS-R) | From the date of randomization to the date of occurrence of radiologic disease progression as determined according to the RECIST v1.1, or death (by any cause), whichever occurs first, assessed up to 10 years. |
| Measure | Description | Time Frame |
|---|---|---|
| Overall survival (OS) | From the date of randomization to the date of death (due to any cause), assessed up to 10 years. | |
| Progression-free survival (PFS) according to HCC modified RECIST (PFS-m) | From the date of randomization to the date of occurrence of radiologic disease progression as determined according to the HCC modified RECIST, or death (by any cause), whichever occurs first, assessed up to 10 years. |
| Measure | Description | Time Frame |
|---|---|---|
| Time to advanced-stage (TTAS) | From randomization to disease progression to Barcelona Clinic Liver Cancer stage C (BCLC-C), assessed up to 10 years. | |
| Time to extrahepatic spread (TTEHS) | From randomization to occurrence of extrahepatic metastasis, assessed up to 10 years. |
Inclusion Criteria:
I.Adequate hematologic function:
II.Adequate hepatic function:
III.Adequate coagulation function:
a)prothrombin activity ≥ 40%
IV.Adequate renal function:
a)Serum creatinine < 110 μmol/L
Exclusion Criteria:
I.Impaired clotting test (platelet count < 60000/mm3, prothrombin activity < 40%) II.Renal failure / insufficiency requiring hemodialysis or peritoneal dialysis. III.Known severe atheromatosis IV.Known uncontrolled blood hypertension (> 160/100 mmHg) V.Patients with known active bleeding (e.g. from GI ulcers, esophageal varices) within 2 months prior to baseline/screening visit or with history or evidence of inherited bleeding diathesis or coagulopathy VI.Clinically significant third space fluid accumulation (i.e., ascites requiring tapping despite use of diuretic or pleural effusion that either required tapping or is associated with shortness of breath)
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| Name | Affiliation | Role |
|---|---|---|
| Ming Zhao, doctor | Principal Investigator, Clinical Professor | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Minimally Invasive Interventional Division, Medical Imaging Center, Sun Yat-sen University Cancer Center, | Guangzhou | Guangdong | 500060 | China |
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| ID | Term |
|---|---|
| D006528 | Carcinoma, Hepatocellular |
| ID | Term |
|---|---|
| D000230 | Adenocarcinoma |
| D002277 | Carcinoma |
| D009375 | Neoplasms, Glandular and Epithelial |
| D009370 | Neoplasms by Histologic Type |
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| RFA | Procedure | Commercial electrode systems are used and the ablation therapy is to be performed according to manufacturer's standard recommendations. All lesions are targeted with CT images during the RFA procedure. |
|
| unAblation-TACEable or unTACEable progression-free survival (uAT-PFS) | From the date of randomization to the date of the following untreatable progression or death by any cause, assessed up to 10 years. |
| Objective response rate (ORR) according to mRECIST (ORR-m) | From date of randomization until the date of study completion, an average of 8 months. |
| Disease control rate (DCR) according to mRECIST (DCR-m) | From date of randomization until the date of study completion, an average of 8 months. |
| Adverse Events | From enrollment to until 30 days following discontinuation of study treatment or until the initiation of the first subsequent therapy following discontinuation of study treatment (whichever occurs first). |
| Time to macrovascular invasion (TTMVI) | From randomization to occurrence of macrovascular invasion, assessed up to 10 years. |
| D009369 | Neoplasms |
| D008113 | Liver Neoplasms |
| D004067 | Digestive System Neoplasms |
| D009371 | Neoplasms by Site |
| D004066 | Digestive System Diseases |
| D008107 | Liver Diseases |