Transarterial chemoembolization plus multi-imaging-guided radiofrequency ablation for elimination of hepatocellular carcinoma nodules measuring 3.1 to 5.0 cm: a single-center study

Abstract

Objective This study was performed to determine whether transarterial chemoembolization (TACE) plus multi-imaging-guided radiofrequency ablation (MIG-RFA) can completely eliminate 3.1- to 5.0-cm hepatocellular carcinoma (HCC) nodules and identify factors that may influence the complete elimination rate (CER) of this therapy. Methods Patients who underwent TACE+MIG-RFA for initial treatment of HCC from January 2008 to January 2016 were retrospectively reviewed. In total, 162 patients with 216 HCC nodules (3.1-5.0 cm) were enrolled. TACE was performed first; MIG-RFA was performed 2 to 4 weeks later. Contrast-enhanced computed tomography was performed 1, 3, 6, and 12 months after TACE+MIG-RFA. If tumor enhancement was not detected by the end of the 12-month follow-up, the lesion was considered completely eliminated. Additional TACE+MIG-RFA was performed for residual lesions. The CER was calculated 12 months after the last therapy. Factors that may influence the CER were analyzed. Results In total, 207 (95.8%) nodules showed no residual lesions and were completely eliminated after one or more TACE+MIG-RFA sessions. Nine (4.2%) nodules were incompletely eliminated even with repeated TACE+MIG-RFA. Tumor location was the only significant prognostic factor influencing the CER. Conclusions TACE+MIG-RFA can eliminate 3.1- to 5.0-cm HCC nodules; the tumor location may affect the treatment outcome.

Keywords: Hepatocellular carcinoma; complete elimination rate; computed tomography; multi-imaging–guided radiofrequency ablation; residual lesions; transarterial chemoembolization; tumor enhancement.

Figure 1.

(a) Transarterial chemoembolization plus multi-imaging–guided radiofrequency ablation for a hepatocellular carcinoma nodule in an area adjacent to the diaphragm and heart. (b) Ultrasonography allowed for safe puncture, and the use of computed tomography allowed for fine adjustment of the needle tip.

Figure 2.

Computed tomography provided a very clear image of the needle tip, ensuring the safety and quality of the ablation process.

Figure 3.

Cone-beam computed tomography provided (a) real-time fluoroscopic imaging and (b) a computed tomography-like reconstructional image that clearly shows the needle tip.