title: Hypertonic saline-enhanced radiofrequency versus chemoembolization sequential radiofrequency in the treatment of large hepatocellular carcinoma.
abstract: OBJECTIVE
  Large hepatocellular carcinoma (HCC) appears to be a major obstacle for radiofrequency ablation (RFA); therefore, attempts to increase the volume of coagulation by injecting hypertonic saline before and/or during RFA have been made. Transarterial chemoembolization (TACE) combines the effect of targeted chemotherapy with ischemic necrosis and eliminates heat loss if combined with RFA. Our aim was to compare the efficacy of hypertonic saline-enhanced RFA versus TACE sequential RFA in the treatment of medium and large nodular HCC.
  
  
  METHODS
  This prospective study was carried out on 40 patients with 40 HCCs between 2008 and 2010 in the Tropical Medicine and Hepatology Department, Faculty of Medicine, Cairo University. They were divided into two groups (20 patients each): the first group received hypertonic saline-enhanced RFA (RFA+HS) and the second group underwent transarterial chemoembolization, followed by RFA (TACE+RFA).
  
  
  RESULTS
  Triphasic computed tomography 1 month after the procedure showed that 17 (85%) patients in each group achieved complete ablation, whereas three (15%) in each group achieved partial ablation. In the RFA+HS group, 12/13 (92%) of medium HCC and 5/7 (71%) of large HCC were successfully ablated. In the TACE+RFA group, 8/8 (100%) medium HCC and 9/12 (75%) of large lesions were successfully ablated. The relation between success rate and lesion diameter was statistically significant only in RFA+HS group. After 6 months, 73.7% of patients in the RFA+HS group and 83.3% of patients in the TACE+RFA group showed maintained ablation (P=0.86).
  
  
  CONCLUSIONS
  RFA+HS and TACE+RFA are safe and equally effective treatments for medium to large HCC.
authors: Tropical Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors: Nabeel M
authors: NM
authors: El-Kady
authors: Gamal
authors: G
authors: Esmat
authors: Ekram H
authors: EH
authors: Mahmoud
authors: Samar K
authors: SK
authors: Darweesh
authors: Sherif H
authors: SH
authors: Mahmoud
authors: Waleed A
authors: WA
authors: Elagawy
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D017115:Catheter Ablation / Q000379:methods*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D012462:Saline Solution, Hypertonic