Combined Radiofrequency Ablation and Transarterial Chemoembolization in Treatment of Unresectable Primary Liver Cancer

Abstract

HCC is the fifth most common cancer worldwide. Surgical therapy, as a curative option, is indicated only in patients with single HCC without portal hypertension and preserved liver function. Hepatic resection of HCC in patients with cirrhosis is associated with significant peri-operative mortality and morbidity. Cirrhotic patients with non-respectable HCC have a poor prognosis influenced by hepatic reserve function and tumor staging [1]. Surgical resection is the standard of care because it has been shown to provide survival benefits, while systemic chemotherapy and radiotherapy are ineffective, Liver transplantation seems to be the choice for mono-focal HCC less than 5 cm in diameter and in selected cases of multifocal HCC, but may be limited by availability of donor organs and a long waiting time [1]. TACE has been shown to reduce systemic toxicity and increase local effects and thus improve therapeutic results. The core concept includes selective embolization of tumour-feeding arteries with a chemotherapeutic agent in an emulsion with iodized oil and subsequent embolization with a particulate agent, The chemotherapeutic regime varies considerably between centers, as does the choice of embolization agent including non-permanent embolic material such as absorbable gelatine powder or polyvinyl alcohol particles, gelatine-coated tri-acryl embospheres or biocompatible polyvinyl alcohol hydro-gels (bead block). Doxorubicin is the most commonly used agent [2]. Because blood flow promotes heat loss, and heat loss may reduce the effectiveness of RFA, a possible way to increase the ablation size of RFA thermal lesions would be to reduce or eliminate the heat loss that is mediated by tissue perfusion, Blood flow to hepatocellular carcinoma lesions can be substantially reduced by the arterial embolization effect of TACE treatment. Moreover, TACE has a strong antitumor effect on hepatocellular carcinoma lesions. However, both TACE and RFA have some well-known limitations. In particular, neither results in adequate control of hepatocellular carcinoma tumors larger than 3 cm. Consequently, multimodal combined treatment is an appealing alternative, especially for patients with large hepatocellular carcinoma [2]. Background: In this study, the outcome of the combination of RFA with TACE was retrospectively evaluated and the effectiveness of this combination treatment on large unresectable primary liver cancer. We carried out a prospective, randomized controlled trial to assess the benefits of combined TACE-RFA for large unresectable hepato-cellular carcinoma. Method: In the present work, 20 patient with single unresectable HCC from Cairo between 35-50 years will be investigated, Patients were randomized into two groups: Group (1): starting by radiofrequency ablation followed by TACE after 4 weeks then follow up by TACE, Group (2): starting by chemo-embolization followed by sequential radiofrequency ablation after 2 weeks from TACE