Abstract
Hepatocellular carcinoma (HCC) is the most common primary cancer of the liver. Hepatectomy and liver transplantation (LT) are regarded as the radical treatment, but great majority of patients are already in advanced stage on the first diagnosis and lose the surgery opportunity. Multifarious image-guided interventional therapies, termed as locoregional ablations, are recommended by various HCC guidelines for the clinical practice. Transarterial chemoembolization (TACE) is firstly recommended for intermediate-stage (Barcelona Clinic Liver Cancer (BCLC) B class) HCC but has lower necrosis rates. Radiofrequency ablation (RFA) is effective in treating HCCs smaller than 3 cm in size. Microwave ablation (MWA) can ablate larger tumor within a shorter time. Combination of TACE with RFA or MWA is effective and promising in treating larger HCC lesions but needs more clinical data to confirm its long-term outcome. The combination of TACE and RFA or MWA against hepatocellular carcinoma needs more clinical data for a better strategy. The characters and advantages of TACE, RFA, MWA, and TACE combined with RFA or MWA are reviewed to provide physician a better background on decision.
Highlights
Liver cancer is estimated to be ranked sixth on most currently diagnosed cancer as well as the fourth main reason of cancer death with about 841,000 new cases and 782,000 deaths occurred in 2018 worldwide [1]
According to the analysis conducted by Livraghi et al [28], a complete necrosis of lesions up to 2 cm was achieved 90% with a locoregional recurrence rate of 1% and the estimable 3-year and 5-year survival rates were 76% and 55%, respectively, whereas another trial conducted by Livraghi et al [30] included 80 Hepatocellular carcinoma (HCC) with the tumors 3.1-5 cm in diameter and 46 HCCs with the tumors 5.19.5 cm in diameter found that the complete necrosis was 61% in the medium-sized tumor group and 24% in the large-sized tumor group (P = 0 001)
Transarterial chemoembolization (TACE) combined with Radiofrequency ablation (RFA) has no advantage for small lesions less than 3 cm, perhaps for the reason that RFA can reach complete necrosis alone making the TACE adding to RFA a superfluous way [9]
Summary
Liver cancer is estimated to be ranked sixth on most currently diagnosed cancer as well as the fourth main reason of cancer death with about 841,000 new cases and 782,000 deaths occurred in 2018 worldwide [1]. Hepatocellular carcinoma (HCC) is the most common type of primary liver neoplasm and one of the most common malignant tumors in the world [2, 3]. Locoregional therapies include transarterial chemoembolization (TACE), percutaneous ethanol injection (PEI), radiofrequency ablation (RFA), microwave ablation (MWA), cryoablation (CA), laser ablation, high-intensity focused ultrasound (HIFU), and irreversible electroporation (IRE) [2, 6]. TACE is recommended as the first-line therapy for BCLC stage B HCC based on the Barcelona Clinic Liver Cancer (BCLC) guidelines. Researchers have revealed that combined therapy was an effective selection on the therapy of patients with early or intermediate HCC at the moment of resection not being viable [9].
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