title: Radiofrequency ablation combined with chemoembolization in hepatocellular carcinoma: treatment response based on tumor size and morphology.
abstract: OBJECTIVE
  To evaluate local therapeutic efficacy of radiofrequency (RF) ablation after chemoembolization for hepatocellular carcinoma (HCC) based on tumor size and morphology.
  
  
  METHODS
  Sixty-four patients underwent RF ablation under ultrasonographic or real-time computed tomographic (CT) fluoroscopic guidance within 2 weeks after chemoembolization. One hundred eight lesions were treated. Sixty-five lesions were small (<or=3 cm), 32 were intermediate in size (3.1-5 cm), and 11 were large (5.1-12 cm). Seventy-four of the HCCs were nodular lesions and the other 34 were nonnodular (multinodular and infiltrative) lesions. Response to treatment was evaluated by dynamic enhanced CT and magnetic resonance imaging. Tumor necrosis was considered to be complete when no foci of enhancement were seen within the tumor and at its periphery.
  
  
  RESULTS
  Complete necrosis was achieved in all lesions regardless of tumor size or morphology. There have been no local recurrences in small and intermediate-sized lesions regardless of tumor morphology during a mean follow-up of 12.5 months. In large HCCs, nodular lesions showed no recurrence, but two of six of nonnodular lesions recurred beyond the thermal lesions created around the tumor. The estimated 1-year survival rate was 98.0% in all patients.
  
  
  CONCLUSIONS
  This combined therapy has a therapeutic effect on small and intermediate-sized HCCs regardless of tumor morphology and is a promising treatment option for large nodular lesions. Control of large nonnodular lesions is still a challenging problem.
authors.affiliation: Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8067, Japan. yama@clin.medic.mie-u.ac.jp
authors.forename: Koichiro
authors.initials: K
authors.lastname: Yamakado
authors.forename: Atsuhiro
authors.initials: A
authors.lastname: Nakatsuka
authors.forename: Shigeru
authors.initials: S
authors.lastname: Ohmori
authors.forename: Katsuya
authors.initials: K
authors.lastname: Shiraki
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakano
authors.forename: Jiro
authors.initials: J
authors.lastname: Ikoma
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Adachi
authors.forename: Kan
authors.initials: K
authors.lastname: Takeda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D017115:Catheter Ablation / Q000009:adverse effects; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome