Abstract
PurposeTo introduce the technique and investigate the clinical efficacy of transcatheter arterial chemoembolization (TACE) in combination with simultaneous DynaCT-guided radiofrequency ablation (RFA) in the treatment of solitary large hepatocellular carcinomas (HCCs) (maximal diameter > 5 cm).Materials and methodsForty-six patients who received TACE combined with simultaneous DynaCT-guided RFA for solitary large HCCs between January 2012 and August 2016 were reviewed, and the success rate, safety, local tumor progression (LTP), and overall survival (OS) were retrospectively investigated. OS and time to progression were analyzed with the Kaplan–Meier method.ResultsTechnical success rate was 100%, average operative time for DynaCT-guided RFA was 45.3 ± 4.8 min, average radiation dose was 730.5 ± 78.8 mGy, and no life-threatening complications were observed. At 1-month follow-up enhanced MRI, complete remission was achieved in 82.6% of patients (38/46), and partial remission in 17.4% (8/46). The median follow-up period was 29.5 months (interquartile range 4.0–69.0 months). At 1, 2, and 3 years after surgery, the LTP rates were 4.3, 13.1, and 30.4%, respectively, and the OS rates were 89.1, 71.7, and 56.5%, respectively.ConclusionDynaCT-guided TACE + RFA is safe and feasible for the treatment of solitary large HCCS. TACE combined with simultaneous RFA provides a new treatment option for solitary large HCCs in which DynaCT has important clinical value.
Highlights
Compared with other countries, large hepatocellular carcinomas (HCCs) have a higher incidence in Asia, especially in China
The exclusion criteria were as follows: (1) patients were unsuitable for interventional treatment due to other serious diseases; (2) patients were sensitive to iodine and femoral puncture was infeasible; (3) patients had large arteriovenous fistula in the liver, involvement of the bile duct, tumor thrombus within the portal vein, and extrahepatic metastasis; (4) the expected survival time was shorter than 3 months; and (5) patients had poor lung function and the duration of breath holding was shorter than 8 s even after breathless training
We studied the time to progression (TTP) and 1, 2, and 3-year survival rates
Summary
Large HCCs (maximal diameter > 5 cm) have a higher incidence in Asia, especially in China This is primarily due to the large Chinese population, poor economic conditions, and limited awareness of proper treatment. Researchers have treated HCCs using immediate combination with TACE and RFA under the guidance of cone-beam CT (CBCT) and satisfactory outcomes were achieved. Newer technologies such as the flat-panel detector digital subtraction angiography (DSA) system with CBCT have become popular in clinical practice, and perspective, photography, DSA, and 3D reconstruction/imaging can be performed simultaneously on the same working bed using DynaCT [such as the Artis Zee DSA system with CBCT (SIEMENS, Germany)] [9]. After TACE under DSA, DynaCT can be used for scanning
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