Subphrenic Versus Nonsubphrenic Hepatocellular Carcinoma: Combined Therapy With Chemoembolization and Radiofrequency Ablation

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This retrospective study was conducted to evaluate the clinical utility of the combination of chemoembolization and real-time CT fluoroscopically guided radiofrequency ablation in the treatment of patients with subphrenic hepatocellular carcinoma (HCC). Patients who had a single HCC with a maximum diameter of 5 cm or less were included in the study. None of the patients was a candidate for surgery, and all underwent combination therapy as initial treatment. The patients were divided into two groups based on tumor location. In all, the 93 men and 38 women (mean age, 67.9 +/- 9.4 years; range, 43-83 years) had 46 subphrenic HCCs and 85 nonsubphrenic HCCs. No differences were found in the pretreatment baseline characteristics of the two patient groups. Safety profiles, local tumor progression rates, and prognoses were compared. Tumor enhancement disappeared after 58 radiofrequency sessions (1.3 sessions/tumor) in patients with subphrenic HCC and after 104 radiofrequency sessions (1.2 sessions/tumor) in patients with nonsubphrenic HCC. The 5-year local tumor progression rates (subphrenic, 3% [95% CI, 0.2-12%]; nonsubphrenic, 9% [95% CI, 3-20%]; p = 0.31) and survival rates (subphrenic, 63% [95% CI, 36-81%]; nonsubphrenic, 69% [95% CI, 53-81%]; p = 0.55) were similar for the two patient groups. Although the incidence of self-limited pneumothorax was significantly higher among the patients with subphrenic HCC (13.8% vs 3.85%; p < 0.03), other complication rates were similar for the two patient groups. Combination therapy with chemoembolization and real-time CT-guided radiofrequency ablation is safe and useful even when HCC is in the subphrenic region.