Effect of Ultrasound-Guided Radiofrequency Ablation in Incompletely Treated Hepatocellular Carcinoma after Transcatheter Arterial Chemoembolization

Abstract

ObjectiveTo evaluate the effectiveness of ultrasound-guided radiofrequency (RF) ablation in patients with incompletely treated hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) and to evaluate possible prognostic factors for this therapy.Subjects and MethodsThirty nine patients with incompletely treated single HCC (≤ 5 cm) after TACE were treated with RF ablation. All patients were evaluated for complete tumor ablation rate, local recurrence-free rate, overall survival rate, and complications. Local recurrence-free rate and overall survival rate were calculated using the Kaplan-Meier method. The possible prognostic factors of local recurrence-free rate and survival rate were analyzed using Cox proportional-hazards regression model.ResultsThe complete tumor ablation rate was 92.3%. Local recurrence-free rates for 1-, 2-, 3-, and 5-years were 81.7%, 63.1%, 53.6%, and 35.7%, respectively. One-, 2-, 3-, and 5-year overall survival rates were 96.9%, 82.9%, 67.8%, and 48.4%, respectively. Among prognostic factors included in the analysis, only tumor diameter (≤ 2 cm versus > 2 cm) was statistically significant in terms of predicting local recurrence. Complications were observed in two patients, one with liver abscess and the other with portal venous thrombosis.ConclusionUltrasound-guided RF ablation could be effective and safe in treating incompletely treated HCC after TACE. The diameter of HCC was a significant prognostic factor for local recurrence.

Predisposing factors for hepatocellular carcinoma recurrence following initial remission after transcatheter arterial chemoembolization

“…No local HCC recurrence was observed in patients treated with a combination of TACE and RFA in the present study. The combination of TACE and RFA has significant advantages in terms of local tumor control and longer patient survival compared with TACE alone (41,42). These findings reinforce the notion that the combination of TACE and RFA resulted in a more efficient microscopic local tumor response compared with TACE alone.…”

The Evolving Role of Local Treatments for HCC in the Third Millennium

“…According to the authors, RFA was recommended as the first choice for favorable local recurrence (defined as tumor size ≤5 cm, focality around prior ablation site, absence of macrovascular invasion, and located >5 mm from important structures); TACE was an alternative treatment for patients with concurrent multiple or large intrahepatic metastases; when local non-surgical treatment was deemed infeasible or failed, salvage liver resection was recommended when liver function reserve was enough and all radiology-found tumors were located within one lobe. Similarly, according to Chang and colleagues, RFA can improve long-term outcomes after incomplete TACE, with results comparable to RFA alone (28). No statistically significant difference was demonstrated in terms of overall survival when comparing RFA versus PEI, surgery versus TACE/TAE, and RFA/PEI versus TACE/TAE according Signoriello and colleagues (29).…”

Computed Tomographic-Guided Radiofrequency Ablation of Recurrent or Residual Hepatocellular Carcinomas around Retained Iodized Oil after Transarterial Chemoembolization

“…Ultrasound is the most commonly implemented guidance tool for RFA, and high technical efficacy and safety was reported in cases of residual or recurrent HCC after TACE (21). However, US targeting is not always possible with tumors that are not easily visualized using US.…”