Radiofrequency ablation in the treatment of small hepatocellular carcinomas: Comparison of the radiofrequency effect with and without chemoembolization

Objective. The purpose of this study was to determine whether a combination of transcatheter arterial chemoembolization using doxorubicin and radiofrequency ablation can increase tumor destruction compared with radiofrequency alone in the treatment for hepatocellular carcinoma. Subjects and Methods. Twenty-one patients with 26 nodules smaller than 3 cm in diameter were treated with radiofrequency ablation. Of these, 10 nodules were treated with a combination of radiofrequency ablation and chemoembolization using doxorubicin. All nodules were evaluated for size of induced coagulation, local recurrence, and complication. Results. The therapeutic areas averaged 27.6x22.3 mm using an electrode with a 2-cm tip and 37.2x29.1 mm using an electrode with a 3-cm tip. With respect to the results for 14 nodules treated using an electrode with a 3-cm tip with or without chemoembolization, the greatest dimension of the area coagulated by combined therapy was significantly larger (longest axis dimension, 39.9+/-4.4 mm; shortest axis dimension, 32.3+/-5.2 mm; n=7 nodules) than areas without chemoembolization (longest axis dimension, 34.6+/-2.6 mm; shortest axis dimension, 26.0+/-3.3 mm; n=7 nodules) (longest and shortest axis dimensions, p<0.05). No recurrence occurred in the nodules smaller than 2 cm in diameter. Among the nodules larger than 2 cm in diameter, one local recurrence was observed in seven nodules treated by combined therapy, while two local recurrences were observed in seven nodules treated by radiofrequency alone. Minor complications developed in three patients, two with persistent high fever and one with biliary stenosis. Conclusion. The combination of radiofrequency ablation and transcatheter arterial chemoembolization using doxorubicin markedly increased the extent of induced coagulation compared with radiofrequency alone, despite a small number of patients and the preliminary nature of this study.