Percutaneous radiofrequency thermal ablation combined with transcatheter arterial embolization in the treatment of large hepatocellular carcinoma

Purpose: To evaluate whether the combination of hepatic segmental transcath eter arterial embolization (TAE) with percutaneous radiofrequency (RF) abla tion can increase the volume of coagulation necrosis to treat patients with large hepatocellular carcinoma (HCC). Method: Fourteen patients with cirrh osis and HCC whose greatest diameter ranged from 3.8 to 6.8 cm (mean, 5.2 c m) underwent segmental TAE followed within 3 days by RF interstitial therma l ablation with an expandable needle electrode inserted into the tumour und er sonographic guidance, after local anesthesia. We made one or more needle electrode insertions depending on tumor shape. Posttreatment necrosis was evaluated by ultrasonography, dynamic computed tomography (CT) and cc-fetop rotein dosage in all cases, repeated every three to four months. Results: T umor ablation was obtained in one session in 11 (78%) patients (with one ne edle electrode insertion in 8 patients), in two sessions in 1, in three ses sions in 2. In a mean follow-up of 13.2 months (range 6-23) two patients di ed from unrelated causes; one patient showed multinodular HCC 6 months afte r the treatment: 4 patients developed new lesions, treated by a new course of RF ablation (3 cases) or by surgery(1 case); therefore 11/12 patients st ill in follow-up were disease-free. No fatal complications were observed. O ne month after the treatment, fluid collection at the site of the ablated t umor was observed in one patient which was percutaneously drained. Conclusi ons: Percutaneous RF thermal ablation performed after TAE effectively treat ed HCCs larger than tumors suitable for segmental TAE or RF application alo ne; the result was achieved in two thirds of the cases in a single session with only one needle electrode insertion.