Hepatocellular carcinoma: Long-term results of combined treatment with laser thermal ablation and transcatheter arterial chemoembolization

PURPOSE: To determine the potential long-term effectiveness of laser therma l ablation (LTA) followed by transcatheter arterial chemoembolization (TACE ) in the percutaneous ablation of large hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Thirty large HCCs 3.5-9.6 cm in diameter (mean diame ter, 5.2 cm) and 15 small HCCs 0.8-3.0 cm (mean diameter, 1.9 cm) were trea ted with ultrasonographically guided LTA with TACE and with LTA alone, resp ectively, in 30 patients: 19 with a solitary large HCC,and 11 with one to t hree additional synchronous small HCCs. A 1.064-mum neodymium yttrium-alumi nium-garnet (Nd-YAC) laser at a power of 5.0 W was coupled with one to four quartz optic fibers that were advanced through 21-gauge needles. Segmental TACE was performed 30-90 days after LTA. All lesions were evaluated for ch ange in size at computed tomography (CT), alpha -fetoprotein (AFP) levels, recurrence rates, and cumulative survival rates. RESULTS: No major complications occurred in 127 LTA sessions. CT showed com plete tumor necrosis in 27 (90%) of 30 large HCCs. Twenty-eight patients we re followed up for 6-41 months(mean, 17.1 months). In 25 patients,all lesio ns appeared stable or smaller at Cf. AFP levels decreased to the normal ran ge in all patients with high pretreatment values. The 1-, 2-, and 3-year lo cal recurrence rate was 7% in large HCCs. Complete tumor necrosis was achie ved in all 15 (100%) small HCCs; none of them recurred locally. The 1-, 2-, and 3-year cumulative survival rates were 92%, 68%, and 40%, respectively. CONCLUSION: LTA followed by TACE is an effective palliative therapy in trea ting large HCCs.