Reply to: “Is Ablation > 30 Days after Transarterial Chemoembolization a “Combined Procedure”?”

Abstract

We appreciate Dr. Brown’s interest in our recent study ( 1 Liu D. Liu M. Su L. et al. Transarterial chemoembolization followed by radiofrequency ablation for hepatocellular carcinoma: impact of the time interval between the two treatments on outcome. J Vasc Interv Radiol. 2019; 30: 1879-1886 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar ) on transarterial chemoembolization followed by radiofrequency (RF) ablation for hepatocellular carcinoma, and we appreciate her comments. In our study, the delayed treatment was determined before the initial transarterial chemoembolization procedure. We enrolled 135 patients with a single recurrent hepatocellular carcinoma (> 3 cm) or multiple (2–5 tumors) recurrent hepatocellular carcinomas who underwent transarterial chemoembolization plus RF ablation from 2007 to 2015 in a single-center retrospective study. Before 2012, no required time interval between transarterial chemoembolization and RF ablation was suggested for patients. Interventional room schedule, patient’s preference, and insurance affected the selection of the time interval. RF ablation was performed on the following day, within 30 days, or > 30 days after transarterial chemoembolization. In 2012, we performed a quantitative contrast-enhanced ultrasound (US) study to analyze the perfusion changes of hepatocellular carcinoma after treatment with transarterial chemoembolization. The results showed that perfusion index of the lesion continued to decrease 1–3 days after transarterial chemoembolization, then was stable at almost the same level until 15 days after transarterial chemoembolization. After 15 days, the perfusion index of the tumor began to recover gradually. However, the perfusion index of the treated tumor within 30 days after transarterial chemoembolization would still be lower than that before transarterial chemoembolization. Thus, we recommend patients to receive RF ablation within 30 days, specifically 3–15 days, after transarterial chemoembolization. However, because studies assessing the efficacy among different time intervals are lacking, some patients had a longer interval before RF ablation to allow the body to recover from the transarterial chemoembolization procedure. Moreover, in some areas of China, the health care insurance system cannot cover the fees of 2 procedures (transarterial chemoembolization and RF ablation) during a single hospitalization, which led some patients to choose to be discharged after the transarterial chemoembolization procedure. For these reasons, some patients underwent RF ablation > 30 days after transarterial chemoembolization. Is Ablation > 30 Days after Transarterial Chemoembolization a “Combined Procedure”?Journal of Vascular and Interventional RadiologyVol. 31Issue 4PreviewI read with interest the study by Liu et al (1) in the December issue of JVIR, in which the authors demonstrate improved outcome in patients with hepatocellular carcinoma treated with transarterial chemoembolization followed by radiofrequency (RF) ablation within 30 days compared with patients in whom RF ablation was performed > 30 days following transarterial chemoembolization. The authors do not specify whether the delayed treatments were planned at the time of treatment allocation or performed post hoc based on subsequent imaging findings. Full-Text PDF