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


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.
Shanghai Institute of Medical Imaging and Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
Zeng-Mei
ZM
Si
Department of Intervention Radiology, Fudan University Shanghai Cancer Center, Shanghai, China.
Guang-Zhi
GZ
Wang
Shanghai Institute of Medical Imaging and Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
Sheng
S
Qian
Shanghai Institute of Medical Imaging and Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
Xu-Dong
XD
Qu
Shanghai Institute of Medical Imaging and Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
Zhi-Ping
ZP
Yan
Shanghai Institute of Medical Imaging and Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
Rong
R
Liu
Shanghai Institute of Medical Imaging and Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China. Electronic address: jianhuawang2011@sina.com.
Jian-Hua
JH
Wang
D055011:Ablation Techniques / Q000009:adverse effects / Q000401:mortality; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D017024:Chemotherapy, Adjuvant; D002681:China; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008872:Microwaves / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden; D018084:Ultrasonography, Interventional