Combined Therapy with Transarterial Chemoembolization and Radiofrequency Ablation for Hepatocellular Carcinoma: Does the Degree of Ethiodized Oil Accumulation within the Tumor Affect the Therapeutic Efficacy?

Combined transarterial iodized oil injection and computed tomography-guided thermal ablation for hepatocellular carcinoma: utility of the iodized oil retention pattern

“…Results of the present study revealed that HCC lesions exhibiting a complete Lipiodol retention pattern were associated with a significantly better LRFS than those with an incomplete pattern. This finding is consistent with other studies reporting that compact Lipiodol retention was associated with a lower risk for local progression after an initial TACE session, as well as in patients who underwent TACE followed by RFA [ 8 , 12 ]. There is accumulating evidence that combination therapy with TACE and thermal ablation can result in better recurrence-free and OS than thermal ablation alone in patients with larger (> 3 cm) HCC tumors [ 19 ].…”

“…However, revascularization of the tumor and Lipiodol washout may occur over time, which may amplify the tissue cooling effect, thus reducing the treatment efficacy of ablation, even in lesions with complete Lipiodol retention [ 6 , 21 , 22 ]. As previously described, the heat-sink effect is more common in lesions with perivascular location, and embolization of the tumor-feeding arteries may reduce the heat-sink effect [ 4 , 8 , 21 ]. Therefore, both subgroups of lesions—perivascular and non-perivascular location—should, theoretically, exhibit better improvement after ablation for lesions with complete Lipiodol retention than for those with incomplete retention.…”

“…In addition, tumor visualization can be improved by iodized oil (Lipiodol, Guerbet Group, Villepinte, France) retention when performing ablation under computed tomography (CT) guidance [ 7 ]. A previous study by Lee et al [ 8 ] demonstrated that intra-tumoral Lipiodol accumulation achieved by TACE before ablation may contribute to reducing local tumor progression in intermediate-size (2–5 cm) HCC lesions after ablation. However, the ablation procedures described by Lee et al were performed exclusively under ultrasound guidance, which cannot be used to fully elucidate the advantage(s) of Lipiodol retention in thermal ablation, especially in the improvement of tumor visualization on non-enhanced CT [ 9 ].…”

Computed tomography-guided radiofrequency ablation combined with transarterial embolization assisted by a three-dimensional visualization ablation planning system for hepatocellular carcinoma in challenging locations: a preliminary study

“…TACE or TAE may occlude the main artery supplying the tumor, and subsequent RFA is more effective, reflected by minimized heat loss by convection. Moreover, TACE combined with RFA has demonstrated synergistic cytotoxic effects in HCC, and studies have demonstrated that TACE combined with RFA provides better efficacy than RFA alone [6,12,13]. The combined use of TACE or TAE with RFA is also applicable to recurrent or residual HCC.…”