The TORCH phase 3 RCT compared TACE combined with subsequent selective radiofrequency ablation (TACE-ablation) vs. TACE alone in 241 patients with Barcelona Clinic Liver Cancer (BCLC) stage B, liver-confined unresectable HCC at 2 tertiary centers in China (May 2015–August 2024).
TACE-ablation nearly doubled median PFS vs. TACE alone (17.7 vs. 7.3 months; HR 0.47; P < .001) and more than doubled median OS (88.6 vs. 35.1 months; HR 0.50; P < .001); untreatable PFS was also significantly longer (35.1 vs. 12.3 months; HR 0.40; P < .001). Grade 3–4 adverse events were similar (23.2% vs. 18.3%).
- Open-label design may introduce performance or assessment bias. - Single-country, 2-center study limits generalizability to non-Chinese or community-based populations. - Benefit was most pronounced in low-to-moderate tumor burden (6-and-12 score ≤12); patients with score >12 had limited representation.
For patients with liver-confined, unresectable BCLC-B HCC—especially those with low to moderate tumor burden—sequential TACE followed by thermal ablation offers substantially better survival than TACE alone and should be considered a preferred treatment strategy. Grade 3–4 toxicity rates remain acceptable and comparable between the two approaches.
