Combined transarterial chemoembolization and radiofrequency ablation for small treatment-naïve hepatocellular carcinoma infeasible for ultrasound-guided radiofrequency ablation: long-term outcomes

Abstract

Background Ultrasound (US)-guided radiofrequency ablation (RFA) for small hepatocellular carcinoma (HCC) is often infeasible due to unfavorable location and poor conspicuity. Those small HCCs can be treated with combined transarterial chemoembolization (TACE) and RFA. Purpose To evaluate long-term outcomes of combined TACE and RFA for small treatment-naïve HCC infeasible for US-guided RFA. Material and Methods Between February 2009 and January 2014, 69 patients with small (≤3 cm) HCC infeasible for US-guided RFA received TACE and subsequent RFA in one session as a first-line treatment. Local tumor progression (LTP), overall survival (OS), and event-free survival rates were evaluated. Univariate and multivariate analyses were conducted to identify prognostic factors. Results Cumulative rates of LTP were 4.4%, 6.8%, 8.2%, 9.5%, and 9.5% at one, two, three, five, and seven years, respectively. Cumulative one-, two-, three-, five-, and seven-year OS rates were 100%, 95%, 89%, 80%, and 80%, respectively. Cumulative one-, two-, three-, five-, and seven-year event-free survival rates were 81%, 63%, 54%, 31%, and 20%, respectively. No significant prognostic factors for LTP, OS, and event-free survival were identified in univariate analysis. Conclusion Combined TACE and RFA appears to be an effective treatment for small treatment-naïve HCC infeasible for US-guided RFA in terms of LTP and OS.

Management of sub-centimeter recurrent hepatocellular carcinoma after curative treatment: Current status and future

“…Therefore, placement of RF electrodes into the tumor would be possible under US, CT, or fluoroscopy guidance. In a previous study[45], as expected, the technical success rate of combined treatment was as high as 99% (93/94) in HCCs 3 cm or smaller. However, more data are needed to assess whether combined treatment is also effective for sub-centimeter HCCs.…”

“…Recently, Hyun et al[45] reported that combined transarterial chemoembolization (TACE) and RF ablation is an effective treatment for HCCs that are not suitable for US-guided RF ablation. Theoretically, intratumoral accumulation of radio-opaque iodized oil used in TACE can make the target tumor visible by either fluoroscopy or CT images.…”

Safety and effectiveness of multi-antenna microwave ablation-oriented combined therapy for large hepatocellular carcinoma

“…21–23 Indeed, studies of combined therapy for small and intermediate-sized HCC have demonstrated good feasibility and tolerability, enhanced local control, low levels of tumor progression, and improved survival. 24,25 However, many of these studies have used radiofrequency ablation or only single-antenna MWA.…”

Precision Embolism: Biocompatible Temperature‐Sensitive Hydrogels as Novel Embolic Materials for Both Mainstream and Peripheral Vessels

“…Transcatheter arterial chemoembolization (TACE) is a minimally invasive and nonsurgical technique to treat advanced tumors through introducing embolic reagents and chemotherapeutic drugs into arteries and capillaries. [ 1–5 ] Although many interesting embolic materials have been used for TACE, their inherent defects still limited their clinical application. For examples, the solid embolic reagents, such as polyvinyl alcohol (PVA), gelatin sponge, and alginic acid microspheres, are demonstrated of desired mechanical strength, but they underperform in blocking peripheral vessels along with collateral circulatory formation due to the limited size distribution ( Scheme A).…”