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ACE combined with radiofrequency ablation for massive primary hepatocellular carcinomas:a clinical therapeutic evaluation

Objective To discuss the therapeutic efficacy of transcatheter arterial chemoembolization(TACE) combined with radiofrequency ablation(RFA) for massive hepatocellular carcinomas.Methods During the period from August 2009 to September 2010,a total of 30 patients with large hepatocellular carcinoma(at least one lesion with the diameter over 5 mm) were treated with TACE in combination with RFA.After the procedure,all patients were followed-up for 4-20 months.The outcomes were evaluated by the clinical relief of symptoms,the tumor's size determined on B-sonograph or CT scanning,hepatic function,alpha fetoprotein(AFP) levels,the occurrence of procedure-related complications and survival time.A p-value of less than 0.05 was considered to indicate a significant difference.Results The whole procedure was successfully performed in all 30 patients.After the treatment,the symptoms were relived and the clinical conditions were improved in all patients.Follow-up CT scanning showed that complete necrosis was seen in 43.90% of lesions(18/41),and partial necrosis was detected in 56.10% of lesions(23/41).The AFP level decreased in 83.33% of patients(25/30),increased in 10% of patients(3/30) and was unchanged in 2 cases(6.67%).The complications included epidermal burn(n = 1),refractory hiccup(n = 2),intra-hepatic bleeding(n = 3),liver abscess(n = 1) and severe postoperative hypoproteinemia(n = 4).The median survival period was 8.1 months and the mean survival period was 11.1 months.Conclusion TACE together with RFA is an effective treatment for inoperable large hepatocellular carcinomas.However,the clinical long-term efficacy needs to be clarified by further follow-up observation and random control trials with large sample.