Combination Therapies in the Management of Large (≥ 5 cm) Hepatocellular Carcinoma: Microwave Ablation Immediately Followed by Transarterial Chemoembolization

• Published in: Journal of vascular and interventional radiology Vol. 27; no. 10; pp. 1577 - 1583
• Main Authors: Si, Zeng-Mei, MD, Wang, Guang-Zhi, MD, PhD, Qian, Sheng, MD, Qu, Xu-Dong, MD, PhD, Yan, Zhi-Ping, MD, PhD, Liu, Rong, MD, PhD, Wang, Jian-Hua, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2016
• Subjects: Ablation Techniques - adverse effects; Ablation Techniques - mortality; Adult; Aged; Aged, 80 and over; Angiography; Carcinoma, Hepatocellular - diagnostic imaging; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - therapy; Chemoembolization, Therapeutic - adverse effects; Chemoembolization, Therapeutic - methods; Chemoembolization, Therapeutic - mortality; Chemotherapy, Adjuvant; China; Disease-Free Survival; Female; Humans; Kaplan-Meier Estimate; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - therapy; Male; Microwaves - adverse effects; Microwaves - therapeutic use; Middle Aged; Radiology; Retrospective Studies; Risk Factors; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Tumor Burden; Ultrasonography, Interventional; PR; progressive disease; OS; progression-free survival; radiofrequency; complete response; MW; AFP; CR; PD; RF; overall survival; α-fetoprotein; PFS; partial response; microwave
• ISSN: 1051-0443; 1535-7732
• DOI: 10.1016/j.jvir.2016.02.014

Abstract Purpose To evaluate the safety and efficacy of microwave (MW) ablation combined with transarterial chemoembolization in a single stage for the treatment of large (≥ 5 cm) hepatocellular carcinoma (HCC). Materials and Methods From March 2013 to January 2015, 66 patients (54 men and 12 women; mean age, 54 y; range, 29–83 y) with 72 large HCC lesions were included in this study. Eighteen (27.3%) had Barcelona Clinic Liver Cancer class B disease, and 48 (72.7%) had class C disease. Seventy-nine percent of patients (n = 52) had hepatitis B virus infection. The average tumor size was 9.0 cm ± 3.9, ranging from 5 to 19 cm. MW ablation was performed under ultrasound guidance, immediately followed by chemoembolization. Local tumor response, progression-free survival (PFS), and overall survival (OS) were assessed. Results The technique was successfully performed in all patients. Complete response (CR) was achieved in 28 cases (42.4%), and partial response (PR) was achieved in 34 cases (51.5%) at 1 month after the procedure. The objective response rate (ie, CR plus PR) was 93.9%. Median PFS and OS times were 9 months and 21 months, respectively. The 6-, 12-, and 18-month OS rates were 93.9%, 85.3%, and 66.6%, respectively. Hemorrhage was detected in three patients and arteriovenous fistula in two patients after MW ablation; all were promptly treated with embolization. There were no liver abscesses, bile-duct injuries, or other major procedure-related complications. Conclusions MW ablation immediately followed by chemoembolization is safe and effective in the treatment of large HCC lesions.