Midterm results of chemoembolization with drug eluting beads followed by percutaneous microwave ablation of hepatocellular carcinoma: single center evaluation of safety and efficacy

Abstract

Purpose To evaluate the local efficacy, safety, and survival at midterm follow up using transarterial chemoembolization with doxorubicin eluting beads (DEB-TACE) followed by percutaneous microwave ablation (MWA) in the treatment of hepatocellular carcinoma (HCC). Materials and Methods Over an 18 month period, 45 patients with unresectable HCC (32 men, 13 women; mean age 66) underwent 49 percutaneous CT guided MWA procedures using the Certus 140 2.45GHz gas cooled probe (Neuwave Medical, Madison, WI). All patients were treated with DEB-TACE using doxorubicin loaded 100-300 LC Beads (Biocompatibles,Surrey,UK) 24 hours prior to MWA. A retrospective analysis was performed using patient medical records to review tumor location, size, and technical and clinical outcomes. Follow-up consisted of an office visit and imaging with CT and/or MR at one month and every 3-4 months thereafter. Complete response was defined as disappearance of arterial enhancement in target lesions. Primary endpoints included: rate of complete ablation, local tumor progression within 1cm from ablated site, and 30 and 90 day major and minor adverse events. Results A total of 49 tumors were treated (median size 2.1 cm; range 0.8-5.0). Lesion size included: 5cm - 0/45 (0%). Procedural technical success was 100% using a standard MWA protocol. Complete ablation was achieved at 1-,3-,6- and 9-month follow up in 38/39 (97.4%), 26/27 (96.3%), 15/16 (93.8%), and 12/12 (100%) patients, respectively. Local tumor progression rates at the ablated site at 1-,3-,6- and 9-month follow up were 2.6%, 3.7%, 6.2%, and 0%, respectively. Mortality was 0% at 30 and 90 days. Length of hospital stay was 2 days in 36/45 (80%) patients. Pneumothorax requiring chest tube occurred in 4/49 (8.2%) ablations. Minor adverse events included: post procedural pain and transient low grade fever occurring in 35/45 (77.8%) and 6/45 (13.3%) patients, respectively. Conclusion Combination therapy using DEB-TACE and percutaneous MWA is a safe and locally effective treatment for unresectable HCC as evidenced by high rates of complete ablations and low rates of major adverse events.