Percutaneous radiofrequency ablation combined with chemoembolization in hepatocellular carcinoma: assessment of palliative treatment

Introduction: In palliation of hepatocellular carcinoma the best results are obtained in tumours not bigger than 3 cm with alcohol injections and thermoablation. Tumours exceeding 5 cm are most often treated with chemoembolization. Our experience with combination of chemoembolization and percutaneous thermoablation is presented below.
Aim: Assessment of factors which influence outcomes and usefulness of this treatment method.
Material and methods: The study group consisted of 25 patients with HCC. Four methods of visualization were applied: MRI, ultrasound, power Doppler and DSA done before the procedure, one day after, and repeated every 4 weeks. Completeness of the procedure, tumour size and vascularization as well as liver blood flow were assessed.
Results: Forty-five combined procedures were performed. Complete remission was achieved in 5 (20%) cases. Foci of hepatocellular carcinoma were shown to shrink after exposure to combined therapy (p < 0.01). Smaller size tumours were statistically more likely to decrease with applied therapy (r = –0.41). Combination therapy proved to decrease blood supply of the tumour (p < 0.01).
Conclusions:
1. Combination of chemoembolization and percutaneous thermoablation for non-resectable hepatocellular carcinoma is relatively minimally invasive and allows for palliative therapy of the tumour.
2. Combination procedure inhibited tumour growth or decreased tumour size in all studied cases.
3. Complete response is unlikely with combination therapy and is as low as 20%.
4. Response to chemoembolization and thermoablation combination therapy depends on tumour size and not on tumour vascularization.
5. Contrast-enhanced MRI and ultrasound with power Doppler option are very helpful in monitoring of the patient after combination therapy.