title: Comparison of single-session transarterial chemoembolization combined with microwave ablation or radiofrequency ablation in the treatment of hepatocellular carcinoma: a randomized-controlled study.
abstract: BACKGROUND
  Globally, hepatocellular carcinoma (HCC) is the third most frequent cause of cancer-related mortality. In recent years, transarterial chemoembolization, radiofrequency ablation, and microwave ablation (MWA) have been accepted as treatment modalities for patients with surgically unresectable HCC.
  This study aimed to compare combination treatment with radiofrequency or MWA, followed by transarterial chemoembolization, and performed in a single session.
  
  
  METHODS
  This study was carried out on 50 patients with nonresectable single-lesion HCC, who were divided into three groups: group A included 20 patients treated by transcatheter hepatic arterial chemoembolization, group B included 20 patients treated by radiofrequency thermal ablation combined with transcatheter arterial chemoembolization, and group C included 10 patients treated by MWA combined with transcatheter arterial chemoembolization. The combined treatments were performed in a single session, with the ablation performed first.
  
  
  RESULTS
  The total success rate in this study at 6 months following the procedure was 50% in group A, 70% in group B, and 80% in group C. Major complications were recorded in 22% of patients. The number of complications was the highest in group A.
  
  
  CONCLUSIONS
  Combined ablation with chemoembolization is superior in the treatment of nonresectable single masses larger than 4 cm. Transcatheter arterial chemoembolization and ablation can be performed safely and successfully during a single session, which has not been found to decrease the response rates to treatment. Combined treatment with MWA is more effective in terms of tumor response, and results in the same complication rate as with radiofrequency, but less than chemoembolization alone.
authors.affiliation: aDepartment of Tropical Medicine and Infectious Diseases, Faculty of Medicine, Tanta University, Tanta bDepartment of Radiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Elshazly
authors.initials: E
authors.lastname: Sheta
authors.forename: Ferial
authors.initials: F
authors.lastname: El-Kalla
authors.forename: Mohamed
authors.initials: M
authors.lastname: El-Gharib
authors.forename: Abdelrahman
authors.initials: A
authors.lastname: Kobtan
authors.forename: Mohammed
authors.initials: M
authors.lastname: Elhendawy
authors.forename: Sherief
authors.initials: S
authors.lastname: Abd-Elsalam
authors.forename: Loai
authors.initials: L
authors.lastname: Mansour
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Amer
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000473:pathology / Q000628:therapy*; D017115:Catheter Ablation / Q000009:adverse effects; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects; D017024:Chemotherapy, Adjuvant; D004534:Egypt; D006801:Humans; D008113:Liver Neoplasms / Q000098:blood supply / Q000473:pathology / Q000628:therapy*; D008872:Microwaves / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden