Sequential Use of Transhepatic Arterial Chemoembolization and Bipolar Radiofrequency Ablation in the Clinical Therapy of Hepatocellular Carcinoma

Abstract

This retrospective study investigated the clinical application of sequential therapy with transarterial chemoembolization (TACE) and CT-guided radiofrequency ablation (RFA) using a bipolar needle in treating hepatocellular carcinoma (HCC) tumors of different sizes. The study included patients (N = 46) with HCC from Shengjing Hospital of China Medical University who had received TACE and RFA from November 2012 to November 2013. Eligible patients had an Eastern Cooperative Oncology Group (ECOG) score of 0-1, a Child-Pugh grade of A-B, and no contradictions for TACE and/or RFA. Fifty one hepatic lesions of varying sizes were treated with TACE followed by RFA. Clinical response and 1- and 2-year survival rates were assessed. The frequency of complete and incomplete ablation following therapy was significantly different across the varying RFA pin numbers and the maximum diameter of the lesion (p ≤ 0.001). A greater percentage (97.3%) of lesions that were ≤3 cm in diameter were completely ablated compared with lesions that were 3-5 cm (88.9%) and >5 cm in diameter (20%). The median survival time of patients was 16.5 months, and the 1- and 2-year survival rates were 95.7% and 69.3%, respectively. There were only a limited number of complications, all of which were minor. These included hemothorax (4.3%), abdominal hemorrhage (10.9%), and abdominal hemorrhage with minor pneumothorax (2.2%). This study found that the sequential treatment with TACE and CT-guided RFA using a bipolar needle is effective and well tolerated in patients with HCC and that the effectiveness of treatment is dependent on tumor size.

Copy number profiling of circulating free DNA predicts transarterial chemoembolization response in advanced hepatocellular carcinoma

“…Previous studies have demonstrated that lipiodol deposition in HCC tumour might be used as an imaging indicator to evaluate TACE therapeutic efficacy [21][22][23][24]. By identifying the lipiodol deposition patterns on post-TACE CT, we first calculated the proportion of lipiodol deposition in all enrolled patients and categorized them into two different groups with 50% as cut-off according to previous reports [25][26][27] (Fig. 5A).…”

A Recent Advance in Image-Guided Locoregional Therapy for Hepatocellular Carcinoma

“…Histologic studies performed with liver specimens from patients who underwent RFA as bridge treatment before transplantation showed that the presence of large (≥3 mm) abutting vessels results in a decrease of about 50% in the rate of complete tumor necrosis because of the heat loss due to perfusion-mediated tissue cooling in the area to be ablated [25]. The methods to overcome the heat sink effect include pharmacologically decreasing blood flow [26,27,28,29], temporary vascular balloon occlusion [30,31], and intra-arterial embolization [32,33]. A combination of TACE followed by RFA is the most widely used technique aiming to minimize heat loss due to the heat sink effect, and the effectiveness of this combination treatment has been confirmed by several investigators [34,35,36,37,38,39].…”

Safety and Local Efficacy of Laser Ablation for the Extrahepatic Metastasis of Hepatocellular Carcinoma: An Available Treatment Strategy

“…A previous study demonstrated that tumor size affected the complete tumor ablation of LA [39]. In fact, tumor size is also a significant factor affecting the local efficacy of ablation in other thermal ablation techniques including RFA and MWA [40][41][42]. Combined RFA and ethanol injection could increase the range of coagulative necrosis and enlarge the ablation volume [43].…”