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

Abstract

Background: In patients with a large, unresectable hepatocellular carcinoma (HCC), the primary recommendation is for transarterial chemoembolization (TACE) but used alone TACE is not typically curative. Combinations of TACE followed in a delayed fashion by single-applicator thermal ablation have also been suboptimal. As an alternative, we investigated the combination of TACE followed within 1–3 days by multi-antenna microwave ablation (MWA) in patients with a large HCC, to determine the feasibility, safety, local control, and short-term survival rates of this approach. Methods: We retrospectively studied 43 patients with a large HCC (mean diameter, 8.8 cm; SD, 2.8 cm) treated between July 2015 and July 2018, who underwent TACE followed within 3 days by multi-antenna simultaneous MWA. We measured the liver and renal function before and after treatment, recorded complications, used three-dimensional software and imaging to calculate tumor necrosis rates at 1 month after therapy, and calculated overall survival (OS) and progression-free survival (PFS) using the Kaplan–Meier method. Results: Mean follow up was 12.2 (range, 3.5–35.6) months. All patients completed the treatment protocol. At 1 month after combined therapy, tumor necrosis was complete in 16 (37.2%), nearly complete in 19 (44.2%), and partial in 8 (18.6%) patients. The 1- and 2-year OS rates were 64.0% and 46.8%, respectively, with a median OS of 23.0 months; and the 1- and 2-year PFS rates were 19.9% and 4.4%, respectively, with a median PFS of 4.2 months. A transient change in liver function occurred 3 days after MWA but resolved within 1 month. Only two patients had major complications, which were treatable and resolved. Conclusion: Multi-antenna MWA-oriented combined therapy is feasible and well tolerated, and it results in satisfactory initial local control and short-term survival in some but not all patients with a large HCC.

Transcatheter arterial chemoembolization combined with simultaneous DynaCT-guided microwave ablation in the treatment of small hepatocellular carcinoma

“…In the present study, the clinical effect of TACE combined with simultaneous DynaCT-guided MWA appeared superior to that caused by single application of TACE [31]. The progression-free survival of the combination treatment was significantly higher than that noted from single TACE treatment (P = 0.019).…”

Safety and effectiveness of percutaneous microwave ablation using combined computed tomography and ultrasound-guided imaging in patients with hepatocellular carcinoma: A prospective study

“…After treatment, AFP among the three groups continued to decline, and the liver and renal function showed no nonreversible damage compared to preoperative values. These results were consistent with past studies [23] demonstrating the validity and safety of MWA.…”

Security and efficiency of percutaneous microwave ablation by combining computer tomography- with ultrasound-guided in patients with BCLC-A1-3 hepatocellular carcinoma

“…After treatment, AFP among three groups had a continued momentum of decline, the liver and renal function were no non-reversible damage comparing to preoperative, these results were consistent with past experiments [23], demonstrated the validity and security of MWA.…”