Radiofrequency Ablation Combined With Chemoembolization: Treatment of Recurrent Hepatocellular Carcinomas After Hepatectomy

Abstract

The purpose of this study is to evaluate the treatment effect and prognostic factors of radiofrequency ablation (RFA) combined with chemoembolization for patients with recurrent hepatocellular carcinomas (HCCs) after hepatectomy. Fifty-five consecutive patients who received combination therapy as a curative treatment of recurrent HCCs after hepatectomy were included in this retrospective study. The mean maximum tumor diameter was 2.2 cm (range, 1.0-4.8 cm). Under CT fluoroscopic guidance, RFA was performed 1-2 weeks after chemoembolization. Technique effectiveness rates, complications, local tumor progression rates, survival rates, and prognostic factors were evaluated. Tumor enhancement disappeared on contrast-enhanced CT images in all patients after 72 RFA sessions (technique effectiveness rate, 100%). Pneumothorax requiring chest drainage was the only major complication that developed in one RFA session (1%). Four of 55 patients (7%) showed local tumor progression. New tumors emerged in the untreated liver in 27 patients (49%) during the mean follow-up of 35 months (range, 1-82 months). The 5-year overall and recurrence-free survival rates after combination therapy were 74% (95% CI, 54-87%) and 28% (95% CI, 14-45%), respectively. The presence of a single tumor at initial hepatectomy and a low α-fetoprotein level (≤ 100 ng/mL) at recurrence were significantly favorable independent factors affecting overall and recurrence-free survival. For treatment of recurrent HCCs after hepatectomy, RFA combined with chemoembolization is a useful therapeutic option. This study identified prognostic factors that will help to stratify patients with recurrent HCCs after hepatectomy.