title: Transcatheter arterial chemoembolization followed by immediate radiofrequency ablation for large solitary hepatocellular carcinomas.
abstract: OBJECTIVE
  To assess the technical safety and efficacy of transcatheter arterial chemoembolization (TACE) combined with immediate radiofrequency ablation (RFA) for large hepatocellular carcinomas (HCC) (maximum diameter ≥ 5 cm).
  
  
  METHODS
  Individual lesions in 18 patients with HCCs (mean maximum diameter: 7.5 cm; range: 5.1-15.5 cm) were treated by TACE combined with percutaneous RFA between January 2010 and June 2012. All of the patients had previously undergone one to four cycles of TACE treatment. Regular imaging and laboratory tests were performed to evaluate the rate of technical success, technique-related complications, local-regional tumor responses, recurrence-free survival time and survival rate after treatment.
  
  
  RESULTS
  Technical success was achieved for all 18 visible HCCs. Complete response (CR) was observed in 17 cases, and partial response was observed in 1 case 1 mo after intervention. The CR rate was 94.4%. Local tumors were mainly characterized by coagulative necrosis. During follow-up (2-29 mo), the mean recurrence-free survival time was 16.8 ± 4.0 mo in 17 cases of CR. The estimated overall survival rate at 6, 12, and 18 mo was 100%. No major complications were observed. Levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in the blood of 17 patients transiently increased on the third day after treatment (ALT 200.4 ± 63.4 U/L vs 24.7 ± 9.3 U/L, P < 0.05; AST 228.1 ± 25.4 U/L vs 32.7 ± 6.8 U/L, P < 0.05). Severe pain occurred in three patients, which was controlled with morphine and fentanyl.
  
  
  CONCLUSIONS
  TACE combined with immediate RFA is a safe and effective treatment for large solitary HCCs. Severe pain is a major side effect, but can be controlled by morphine.
authors.affiliation: Department of Interventional Radiology, PLA General Hospital, Beijing 100853, China.
authors.forename: Zhi-Jun
authors.initials: ZJ
authors.lastname: Wang
authors.forename: Mao-Qiang
authors.initials: MQ
authors.lastname: Wang
authors.forename: Feng
authors.initials: F
authors.lastname: Duan
authors.forename: Peng
authors.initials: P
authors.lastname: Song
authors.forename: Feng-Yong
authors.initials: FY
authors.lastname: Liu
authors.forename: Zhong-Fei
authors.initials: ZF
authors.lastname: Chang
authors.forename: Yan
authors.initials: Y
authors.lastname: Wang
authors.forename: Jie-Yu
authors.initials: JY
authors.lastname: Yan
authors.forename: Kai
authors.initials: K
authors.lastname: Li
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D017115:Catheter Ablation / Q000009:adverse effects / Q000401:mortality; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D009020:Morphine / Q000627:therapeutic use; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000401:mortality; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine
keywords: Combination therapy; Large hepatocellular carcinoma; Radiofrequency ablation; Synchronism; Transcatheter arterial chemoembolisation