|Year : 2016 | Volume
| Issue : 7 | Page : 217-220
Clinical study of transcatheter arterial chemoembolization combined with microwave ablation in the treatment of advanced hepatocellular carcinoma
Wei Li, Wenling Man, Huanqing Guo, Po Yang
Department of Interventional Therapy and Vascular Surgery, Fourth Clinical Medical College, Harbin Medical University, Harbin, Heilongjiang, China
|Date of Web Publication||21-Feb-2017|
Department of Interventional Therapy and Vascular Surgery, Fourth Clinical Medical College, Harbin Medical University, Harbin 150001, Heilongjiang
Source of Support: None, Conflict of Interest: None
Objective: To evaluate the safety and efficacy of transcatheter arterial chemoembolization (TACE) combined with percutaneous microwave ablation (MWA) in the treatment of advanced hepatocellular carcinoma (HCC).
Materials and Methods: Three thousand cases of advanced HCC patients were randomly divided into two groups: 1500 cases in the treatment group were treated with TACE combined with MWA and 1500 cases in the control group were treated with TACE.
Results: The effective rate of the treatment group and control group was 71.4% and 42.8%, respectively, and the difference between the two groups was statistically significant (P < 0.05). During the follow-up period at 6, 12, 18, and 24 months postoperatively, the survival rates of the treatment group were 88.1%, 73.8%, 52.3%, and 33.3%, and the survival rates of the control group were 76.2%, 57.1%, 30.9%, and 9.5%, respectively. There was no significant difference in postoperative complications between the two groups.
Conclusion: It is safe and effective to use TACE combined with MWA in the treatment of advanced HCC, and the effect of combined treatment is better than that of TACE alone.
Keywords: Chemoembolization, hepatocellular carcinoma, interventional radiology, microwave ablation
|How to cite this article:|
Li W, Man W, Guo H, Yang P. Clinical study of transcatheter arterial chemoembolization combined with microwave ablation in the treatment of advanced hepatocellular carcinoma. J Can Res Ther 2016;12, Suppl S3:217-20
|How to cite this URL:|
Li W, Man W, Guo H, Yang P. Clinical study of transcatheter arterial chemoembolization combined with microwave ablation in the treatment of advanced hepatocellular carcinoma. J Can Res Ther [serial online] 2016 [cited 2021 Mar 3];12:217-20. Available from: https://www.cancerjournal.net/text.asp?2016/12/7/217/200598
| > Introduction|| |
At present, transcatheter arterial chemoembolization (TACE) is the first choice for the treatment of patients with advanced hepatocellular carcinoma (HCC) (>5 cm), which cannot be surgically removed, but the recurrence rate is high and the treatment effect is not good. Studies have shown that TACE combined with other interventional therapy has obvious advantages, and it can reduce the recurrence rate and prolong the survival time. Herein, we compared the efficacy of TACE combined with microwave ablation (MWA) and TACE alone in the treatment of large HCC.
| > Materials and Methods|| |
This study was approved by the Ethics Committee of Harbin Medical University and obtained with informed consent of patients. Data of 3000 cases of HCC were collected from December 2005 to December 2015, including 1786 males and 1214 females, aged 35–67 years old, with a median age of 44.6 years. Among these, clinicopathological data of patients with HCC were confirmed by ultrasound or computed tomography (CT)-guided biopsy before treatment. All the patients were in stage B according to the Barcelona Clinic Liver Cancer staging system. Inclusion criteria were as follows: (1) diameter of lesions was between 3 and 6 cm; (2) unresectable; (3) associated with vascular invasion, but without distant organ metastases; (4) without a history of hepatic encephalopathy; and (5) without severe coagulation disorder. The basic situation of the patients and tumor characteristics are shown in [Table 1].
We used 4FRH catheter (Terumo), 2.7F micro-catheter (Terumo), 0.038 inch super smooth hydrophilic guidewire (Cordis), MWA probe (ECO-100A17, Eco). Equipment is flat-panel-detector digital angiography system (Allu raXperFD-20, Philips), 16-row spiral CT (SomAToM Emotion, Siemens), MWA instrument (ECO-100A1, Eco).
The operation method of TACE: Seldinger technique was used to percutaneous femoral artery insertion, and then tumor vessels were showed by digital subtraction angiography. Leading 4FRH catheter to proper hepatic artery, left or right hepatic artery, 500–1000 mg fluorouracil, and 40–60 mg cisplatin were infused to catheter, and 10–30 mL ultra-liquid iodized oil mixed with 10–20 mg epirubicin-gemcitabine as chemoembolization. MWA: 1–4 weeks after patients treated with TACE, enhanced CT/magnetic resonance imaging (MRI) was performed to clear whether there were recurrent lesions; CT-guided single or multiple MWA treatment was conducted for relapse region, 40–60 W, 6–15 min. If lesions were reduced to <3 cm after TACE therapy, all patients should undergo MWA treatment; no matter whether the lesions were recurrent. All patients in two groups were reviewed 4–5 weeks after operation; repeated treatment was conducted if there is any recurrence.
All patients were followed up for 3.5–24 months with physical examination, laboratory tests, and image examinations. Enhanced CT/MRI scan is performed monthly for observing morphologic changes of tumors and metastasis. Blood routine, liver function, and alpha fetal protein are postoperative reexamined, and the patient's survival time is recorded.
Efficacy evaluation was based on improved RECIST criteria: (1) complete remission (CR): lesions enhancement disappeared in the arterial phase; (2) partial remission (PR): the longest diameter of lesions and reduce the more than 30%; (3) stable disease: does not meet the PR or progressive disease (PD); (4) PD: the longest diameter of lesions and increased by 20% or more, or the emergence of new diseases; (5) efficient response remission (RR): CR + PR.
All statistical analyses were carried out using the SPSS 17 statistical software package. P < 0.05 was considered statistically significant.
| > Results|| |
Compared with the control group, the effective rate of the treatment group was significantly higher (P < 0.05) [Table 2]. There was no recurrence after long-term follow-up in HCC patients [Figure 1].
|Figure 1: A 56-year-old male patient with hepatocellular carcinoma. (a) Enhanced computed tomography scanning showed the lesions located in the right lobe of the liver, and the size of the tumor is about 14.2 cm × 11.5 cm. (b) Postoperative re-examination revealed residual lesions. (c) The patients were followed up for 24 months, and there is no recurrence after microwave ablation therapy for two times, and the size of the tumor is about 8.5 cm × 7.5 cm|
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The 6, 12, 18, and 24 months' survival rate of the treatment group was 88.1%, 73.8%, 52.3%, and 33.3%, respectively. And also, the 6, 12, 18, and 24 months survival rate of the control group was 76.2%, 57.1%, 30.9%, and 9.5%, respectively. The survival rate of the treatment group was significantly higher than the control group (χ2 = 6.415, P = 0.011) [Figure 2].
Postoperative fever, abdominal pain, abdominal distension, vomiting, and other symptoms of embolism syndrome were found in all patients; all these complications can be alleviated in 3–5 days after symptomatic treatment. Transient increase of aminotransferase was observed in patients of both groups and got back to normal in 5–7 days after symptomatic treatment. No fatal complications such as severe liver and kidney function damage and massive hemorrhage were found within the hospital stay after operation and during the period of follow- up.
| > Discussion|| |
TACE is the most common nonsurgical treatment for HCC and leads to a low complete necrosis rate of lesions but with high recurrence rate., The long-term curative effect is not ideal, especially in large HCC, as new collateral circulation was formed after TACE surgery, which seriously affects the effects of treatment. Therefore, how to remove the residual lesions and prevent the formation of collateral circulation has been the focus of attention. So far, there have been multiple clinical trials showed that TACE combined with radiofrequency ablation, MWA, and other means can significantly increase the rate of complete tumor necrosis and prolong the survival period of patients.,,,, However, there is less clinical research on the efficacy of combined interventional therapy for large HCC. MWA is mainly used for the treatment of patients with HCC <5 cm in diameter, especially lesions no larger than 3 cm, and the treatment effect can be comparable with surgical resection, which has the following characteristics: simultaneous multi-probe ablation, short treatment time, high temperature lesions, and little affected by cooling effect of blood flow., In this study, most of the blood flow in the large HCC were blocked after TACE treatment, resulting in focal ischemic necrosis. Enhanced CT or MRI was rechecked after operation to investigate the recurrence of tumor; MWA therapy was performed for recurrent or residual lesions, which can thoroughly remove residual active lesions, increase the rate of complete tumor necrosis, and reduce the recurrence rate. The combined treatment significantly prolongs the survival period and has achieved good clinical effect.
TACE combined with MWA had better complete tumor necrosis rate and survival period than that of the simple TACE treatment, which may be related to the following factors: (1) the blood supply of the tumor was reduced after TACE treatment, and subsequently reducing the cooling effect of lesions and peripheral vascular; (2) MWA can directly destroy the tiny blood vessels and small lesions which formed after conventional TACE, effectively prevent the residual lesions; (3) TACE caused tumor necrosis and edema, inflammatory substances, and expand the ablation area; (4) the deposition time of iodized oil in lesions became longer after MWA therapy, and thus the working time of carried chemotherapy drugs can last longer; (5) TACE combined with MWA reduced the times of interventional treatment for HCC, reduced liver damage, and improved quality of life and tolerance in patients.,,
| > Conclusion|| |
TACE combined with MWA is safe and effective in the treatment of large HCC, the combined treatment is more effective than the simple TACE treatment, and it is worth to be widely spread and applied.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2]