Combination of interventional therapies in hepatocellular carcinoma

Many interventional techniques aimed at achieving nonsurgical ablation of h epatocellular carcinoma have been developed and clinically tested over the last decade. Percutaneous image-guided therapies such as ethanol injection and radiofrequency thermal ablation provide an effective means for treating hepatocellular carcinoma lesions smaller than 3cm, but do not ensure succe ssful ablation of larger tumors. In view of the limitations of available in terventional therapies, there is currently a focus on a multimodality strat egy for the treatment of large hepatocellular carcinomas. Combination of tr anscatheter arterial chemoembolization and ethanol injection overcomes the weakness of each of the two procedures, enhancing local therapeutic effect and longterm survival. More recently, a new technique for single-session ab lation of large hepatocellular carcinoma lesions has been devised by combin ing transcatheter hepatic arterial balloon occlusion/embolization and radio frequency treatment. This combined approach substantially increases the the rmal necrosis volume that can be created with respect to the conventional r adiofrequency technique, as a result of the reduction of heat loss caused b y convection. In a pilot multicentric clinical trial performed in 62 patien ts, successful ablation of hepatocellular carcinoma lesions ranging 3.5-8.5 cm in diameter was achieved in 82% of cases in the absence of major complic ations. This new technique seems to have the potential to replace other int erventional methods for the treatment of large hepatocellular carcinoma.