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ORIGINAL ARTICLE
Year : 2016  |  Volume : 12  |  Issue : 7  |  Page : 217-220

Clinical study of transcatheter arterial chemoembolization combined with microwave ablation in the treatment of advanced hepatocellular carcinoma


Department of Interventional Therapy and Vascular Surgery, Fourth Clinical Medical College, Harbin Medical University, Harbin, Heilongjiang, China

Date of Web Publication21-Feb-2017

Correspondence Address:
Po Yang
Department of Interventional Therapy and Vascular Surgery, Fourth Clinical Medical College, Harbin Medical University, Harbin 150001, Heilongjiang
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.200598

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 > Abstract 

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 Sep 21];12:217-20. Available from: https://www.cancerjournal.net/text.asp?2016/12/7/217/200598


 > Introduction Top


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 Top


Materials

Clinical data

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].
Table 1: The basic situation of patients and tumor characteristics

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Equipment

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).

Methods

Treatment method

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.

Follow-up

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

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.

Statistical analysis

All statistical analyses were carried out using the SPSS 17 statistical software package. P < 0.05 was considered statistically significant.


 > Results Top


Tumor control

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].
Table 2: Comparison between the treatment group and control group

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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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Survival rate

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].
Figure 2: The survival curve of patients in two groups

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Postoperative complications

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 Top


TACE is the most common nonsurgical treatment for HCC and leads to a low complete necrosis rate of lesions but with high recurrence rate.[1],[2] 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.[3] 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.[4],[5],[6],[7],[8] 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,[9] which has the following characteristics: simultaneous multi-probe ablation, short treatment time, high temperature lesions, and little affected by cooling effect of blood flow.[10],[11] 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.[12],[13],[14]


 > Conclusion Top


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

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 > References Top

1.
Raoul JL, Sangro B, Forner A, Mazzaferro V, Piscaglia F, Bolondi L, et al. Evolving strategies for the management of intermediate-stage hepatocellular carcinoma: Available evidence and expert opinion on the use of transarterial chemoembolization. Cancer Treat Rev 2011;37:212-20.  Back to cited text no. 1
    
2.
Imai N, Ishigami M, Ishizu Y, Kuzuya T, Honda T, Hayashi K, et al. Transarterial chemoembolization for hepatocellular carcinoma: A review of techniques. World J Hepatol 2014;6:844-50.  Back to cited text no. 2
    
3.
Lu LG, Hu BS, Li Y, Luo PF. Clinical study of microwave ablation combined with TACE in the treatment of primary liver cancer. J Pract Radiol 2008;24:957-79.  Back to cited text no. 3
    
4.
Yi Y, Zhang Y, Wei Q, Zhao L, Han J, Song Y, et al. Radiofrequency ablation or microwave ablation combined with transcatheter arterial chemoembolization in treatment of hepatocellular carcinoma by comparing with radiofrequency ablation alone. Chin J Cancer Res 2014;26:112-8.  Back to cited text no. 4
    
5.
Liu C, Liang P, Liu F, Wang Y, Li X, Han Z, et al. MWA combined with TACE as a combined therapy for unresectable large-sized hepotocellular carcinoma. Int J Hyperthermia 2011;27:654-62.  Back to cited text no. 5
    
6.
Xu LF, Sun HL, Chen YT, Ni JY, Chen D, Luo JH, et al. Large primary hepatocellular carcinoma: Transarterial chemoembolization monotherapy versus combined transarterial chemoembolization-percutaneous microwave coagulation therapy. J Gastroenterol Hepatol 2013;28:456-63.  Back to cited text no. 6
    
7.
Yin X, Zhang L, Wang YH, Zhang BH, Gan YH, Ge NL, et al. Transcatheter arterial chemoembolization combined with radiofrequency ablation delays tumor progression and prolongs overall survival in patients with intermediate (BCLC B) hepatocellular carcinoma. BMC Cancer 2014;14:849.  Back to cited text no. 7
    
8.
Kong P, Wang JP, Dong YY, Yu DP, Sun Y. Clinical application of transcatheter arterial chemoembolization combined with gamma knife in the treatment of primary hepatocellular carcinoma. J Pract Radiol 2012;28:921-39.  Back to cited text no. 8
    
9.
Tombesi P, Di Vece F, Sartori S. Resection vs. thermal ablation of small hepatocellular carcinoma: What's the first choice? World J Radiol 2013;5:1-4.  Back to cited text no. 9
    
10.
Hinshaw JL, Lubner MG, Ziemlewicz TJ, Lee FT Jr., Brace CL. Percutaneous tumor ablation tools: Microwave, radiofrequency, or cryoablation – What should you use and why? Radiographics 2014;34:1344-62.  Back to cited text no. 10
    
11.
Ding J, Jing X, Liu J, Wang Y, Wang F, Wang Y, et al. Comparison of two different thermal techniques for the treatment of hepatocellular carcinoma. Eur J Radiol 2013;82:1379-84.  Back to cited text no. 11
    
12.
Chen G, Tang XJ, Li HB, Qiu SM, Dai F. Evaluation of therapeutic efficacy of transcatheter arterial chemoembolization combined with percutaneous microwave ablation in the treatment of advanced hepatocellular carcinoma. J Clin Radiol 2012;31:710-3.  Back to cited text no. 12
    
13.
Xu W, Gu YM, Wang XT, Xu H, Lu J, Zu MH, et al. Ultrasound guided microwave ablation combined with TACE in the treatment of liver metastases. J Interv Radiol 2012;21:821-4.  Back to cited text no. 13
    
14.
Seki T, Tamai T, Nakagawa T, Imamura M, Nishimura A, Yamashiki N, et al. Combination therapy with transcatheter arterial chemoembolization and percutaneous microwave coagulation therapy for hepatocellular carcinoma. Cancer 2000;89:1245-51.  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

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