Combined Transarterial Chemoembolization with Microwave Ablation versus Microwave Alone for Treatment of Medium Sized Hepatocellular Carcinoma

Abstract

Background & Aims: Hepatocellular carcinoma (HCC) is the fifth most common cancer and the second leading cause of cancer-related deaths. The only definitive treatment for both HCC and cirrhosis is liver transplantation, but long wait times in some regions and a relatively fixed number of donor organs negatively impact access to liver transplantation. The aim of the work was to evaluate and compare the short outcome of patients with medium-sized HCC who will undergo percutaneous microwave ablation (MWA) alone and in combination with TACE. Methods: This prospective study included 40 patients with medium-sized HCC lesions who were classified into two groups; Group A that included twenty patients treated by TACE followed by percutaneous MWA after 2 weeks and group B that included twenty patients treated by 2 sessions of percutaneous MWA with 2 weeks interval. Full history taking, clinical examination, laboratory investigation, abdominal ultrasonography and abdominal tri-phasic computed tomography (CT) with contrast were obtained from the two groups. Laboratory and radiological follow up of the cases were done at 1 and 3 months after the treatment. Results: There was no statistically significant difference in the sociodemographic criteria, laboratory measurement and clinical criteria between the cases in the two study groups before initiation of treatment. The response was slightly better in the combined treatment group, but it did not show a statistically significant difference. The incidence of complications was higher in the MWA group. Conclusion:: Hepatocellular carcinoma is a common complication of HCV related cirrhosis. Association of TACE-MWA led to better response rates than MWA with fewer complications.

Chinese expert consensus on composite ablation system for the treatment of primary liver cancer (2023 edition)

“…This includes methods such as microwave ablation, radiofrequency ablation, laser ablation, high-intensity focused ultrasound ablation, cryoablation, irreversible electroporation, percutaneous ethanol injection, and percutaneous acetic acid injection. Early-stage liver cancer can often be completely cured through direct ablation, while mid-stage liver cancer typically requires a comprehensive treatment strategy combining local ablation with transcatheter arterial chemoembolization, among other techniques [6][7][8] .…”