TACE Plus RFA for Intermediate-Stage Liver Cancer: Phase 3 TORCH Trial

A phase 3 randomized trial published in JAMA Oncology on July 30, 2026 found that adding radiofrequency ablation after transarterial chemoembolization (TACE) lengthened both progression-free and overall survival compared with TACE alone in intermediate-stage (BCLC B) liver cancer. This is the TORCH trial from Sun Yat-sen University Cancer Center in China.

Median progression-free survival was 17.7 vs 7.3 months and median overall survival 88.6 vs 35.1 months. The trial ran at only two Chinese centers, and the clearest benefit was in patients with low or moderate tumor burden.

What is new: the phase 3 TORCH trial

TACE is an interventional radiology (IVR) procedure in which a catheter, inserted through an artery in the groin or wrist, delivers chemotherapy and embolic material into the arteries feeding the liver tumor. It has been the backbone treatment for intermediate-stage liver cancer for more than 20 years, but viable tumor often remains after the procedure and grows back. The investigators considered this residual tumor a major driver of progression, and tested whether burning the remaining tumor with a CT-guided needle electrode (RFA) after TACE would help.

• Design: open-label phase 3 randomized trial, 1:1 allocation
• Comparison: TACE followed by selective RFA (combination arm) vs TACE alone (control arm)
• Period: enrollment May 2015 to August 2024; data cutoff October 31, 2025
• Primary endpoint: progression-free survival (PFS) by RECIST 1.1. Secondary endpoints included overall survival (OS), response, "untreatable" PFS and safety

Who was studied: intermediate-stage (BCLC B) liver cancer

BCLC (Barcelona Clinic Liver Cancer) stage B means liver function is relatively preserved, but tumors are multiple or large enough that surgery or ablation alone cannot remove them in one go. There is no vascular invasion or spread outside the liver. TORCH enrolled 241 patients with liver-confined, unresectable BCLC B hepatocellular carcinoma.

Tumor burden was graded with the "6-and-12" score: the largest tumor diameter (cm) plus the number of tumors (≤6 low, 6–12 intermediate, >12 high). In the combination arm 28.1% scored below 6, 65.3% scored 6–12 and 6.6% above 12; in the control arm the figures were 25.8%, 63.3% and 10.8%. Most patients had low or intermediate tumor burden.

Results: PFS, overall survival and side effects

The comparator is patients treated with TACE alone during the same period. Figures are taken as reported in the abstract of Lyu N et al., JAMA Oncol 2026 (doi:10.1001/jamaoncol.2026.2366) and news coverage.

PFS in the combination arm was more than double that of the control arm, with roughly half the risk of progression (HR 0.47). Overall survival also differed significantly (HR 0.50). The authors reported consistent benefit across subgroups, most meaningful in patients with low or intermediate tumor burden. Severe adverse events were somewhat more frequent with the combination (23.2% vs 18.3%), which the authors described as manageable.

Limitations and interpretation

• Two centers in China. These are results from experienced high-volume cancer centers; whether other countries and hospitals can reproduce them needs confirmation. Patient background, including the cause of liver disease, may also differ by region.
• 88.6 months is still uncertain. Too few deaths have occurred to estimate the upper confidence limit, so the figure may change with longer follow-up.
• Open-label design. Patients and physicians knew which treatment was given.
• Enrollment spanned more than nine years. Post-progression treatment, including immunotherapy, changed a lot in that time, and the published summary gives little detail on it.
• "Selective" ablation. RFA was done where residual tumor could be ablated; it may not apply when tumor location or size makes ablation difficult.

An accompanying JAMA Oncology editorial (MD Anderson Cancer Center and BC Cancer) called the trial randomized evidence of "substantial and durable survival benefit", but noted that Western centers have moved toward radioembolization (Y-90) or TACE with immune checkpoint inhibitors, and called for a head-to-head trial of TACE plus selective ablation versus TACE plus immunotherapy.

Treatment options and the situation in Japan and abroad

This is an overview of where each option stands, not a head-to-head comparison in the same patients.

Japan has long used both RFA and TACE widely for liver cancer, and performing the two in sequence for the same patient is part of clinical practice there. Which patients receive the combination, and whether microwave ablation is used instead of RFA, depends on the hospital and the tumor. In the US and Europe, more hospitals consider Y-90 or drug combinations first, as shown above. If you are considering treatment abroad, first confirm whether the combination is routine care, a clinical trial or self-funded care at that hospital. Basic information on the procedures is in our IVR guide and RFA guide.

What to check and questions for your doctor

• What BCLC stage is my liver cancer, and what is my tumor burden score (largest tumor in cm + number)? Am I within the up-to-7 criteria?
• Is the tumor that remains after TACE in a location and size that RFA or microwave ablation can treat? Is it close to large vessels or bile ducts?
• If combined, what is the interval between TACE and ablation, the hospital stay, and the expected side effects (fever, pain, worsening liver function, bile duct injury)?
• How does this compare with Y-90 or TACE plus immunotherapy in my case?
• Is my liver function (Child-Pugh score) good enough for repeated procedures?

To prepare for a consultation, see five questions before an RFA consultation, and for reading study numbers, how to check the study stage of overseas papers. Results in other organs can differ, as the PELICAN trial of RFA in pancreatic cancer shows.

FAQ

Does everyone live longer with RFA after TACE?

No. TORCH enrolled patients with liver-confined, unresectable BCLC B disease in whom residual tumor after TACE could be ablated. The investigators also reported the clearest benefit in patients with low or intermediate tumor burden.

Are there more side effects with the combination?

Grade 3–4 treatment-related adverse events occurred in 23.2% with the combination and 18.3% with TACE alone. The authors considered them manageable, but risk depends on individual liver function and tumor location.

Is the 88.6-month overall survival a firm number?

No. It is a median estimated while events are still too few to estimate the upper confidence limit. What is clear is the hazard ratio of 0.50, meaning a lower risk of death in the combination arm.

Can I get TACE plus RFA in Japan?

TACE and RFA are widely used for liver cancer in Japan, and combined use occurs. Whether it is offered depends on the hospital and the tumor, so confirm the type of care (routine, clinical trial or self-funded) and the supporting evidence first.

This article summarizes a published study as general information and is not medical advice. Discuss treatment decisions with physicians who have examined the patient.