ObjectiveTo determine the prognostic factors for local recurrence of nodular hepatocellular carcinoma after segmental transarterial chemoembolization.Materials and MethodsSeventy-four nodular hepatocellular carcinoma tumors ≤ 5 cm were retrospectively analyzed for local recurrence after segmental transarterial chemoembolization using follow-up CT images (median follow-up of 17 months, 4-77 months in range). The tumors were divided into four groups (IA, IB, IIA, and IIB) according to whether the one-month follow-up CT imaging, after segmental transarterial chemoembolization, showed homogeneous (Group I) or inhomogeneous (Group II) iodized oil accumulation, or whether the tumors were located within the liver segment (Group A) or in a segmental border zone (Group B). Comparison of tumor characteristics between Group IA and the other three groups was performed using the chi-square test. Local recurrence rates were compared among the groups using the Kaplan-Meier estimation and log rank test.ResultsLocal tumor recurrence occurred in 19 hepatocellular carcinoma tumors (25.7%). There were: 28, 18, 17, and 11 tumors in Group IA, IB, IIA, and IIB, respectively. One of 28 (3.6%) tumors in Group IA, and 18 of 46 (39.1%) tumors in the other three groups showed local recurrence. Comparisons between Group IA and the other three groups showed that the tumor characteristics were similar. One-, two-, and three-year estimated local recurrence rates in Group IA were 0%, 11.1%, and 11.1%, respectively. The difference between Group IA and the other three groups was statistically significant (p = 0.000).ConclusionAn acceptably low rate of local recurrence was observed for small or intermediate nodular tumors located within the liver segment with homogeneous iodized oil accumulation.

The Adrenal gland is the second most common site of metastasis from a hepatocellular carcinoma (HCC) (1). Surgical adrenalectomy has been reported to be an effective treatment for the metastatic tumors (2, 3). However, nonsurgical treatments such as transarterial chemoembolization (TACE) or percutaneous ethanol injection therapy (PEI) have also been reported as potentially equivalent alternatives for these tumors (4). Recently, radiofrequency ablation (RFA) for these tumors has also been reported with favorable clinical results, especially for inoperable patients (5, 6). For intermediate or large adrenal tumors, however, complete necrosis of the adrenal tumors may not be achieved without difficulty. Combination therapy with transarterial chemoembolization (TACE) and RFA can be attempted for this situation. As with liver tumors, it can reduce the heat sink effect by the arterial feeders, and thus can increase the volume of the ablation. We report here a case of a 5.0 cm sized metastatic adrenal tumor from a HCC that was successfully treated with combination therapy of TACE and RFA. Case ReportA 74-year-old man presented with abdominal discomfort and a palpable abdominal mass. An abdominal CT revealed a large liver mass with a measured diameter of 7 cm. The serum alpha-fetoprotein level (AFP) was mea- The adrenal gland is the second most common site of metastasis from a hepatocellular carcinoma (HCC). Radiofrequency ablation (RFA) for these tumors has been reported to be a potentially effective alternative to an adrenalectomy, especially for inoperable patients. However, for intermediate or large adrenal tumors, combination therapy of transarterial chemoembolization (TACE) and RFA can be attempted as it may reduce the heat sink effect. A 74-year-old patient presented with abdominal discomfort. Abdominal CT images revealed a 5.0 cm sized right adrenal mass. A percutaneous biopsy of the adrenal mass revealed a metastatic hepatocellular carcinoma. TACE was performed on the adrenal mass. However, a one-month follow-up CT image revealed a residual viable tumor. RFA was performed for the adrenal tumor six weeks after the TACE. No procedure-related major complications were noted. The serum alpha-fetoprotein level had also been normalized after the treatment, and 10-month follow-up CT images showed no definite evidence of viable adrenal tumor.