Radiofrequency Ablation Combined with Chemoembolization for the Treatment of Hepatocellular Carcinomas Larger than 5 cm

PURPOSE: To evaluate survival, free survival, technical success, technique effectiveness, and safety of radiofrequency (RF) ablation combined with chemoembolization in patients with hepatocellular carcinomas (HCCs) larger than 5 cm. MATERIALS AND METHODS: Patients with Child-Pugh class A or B cirrhosis and three or fewer HCCs with a maximum tumor diameter of 10 cm were included. Twenty patients with 32 HCCs were included. There were 1.6 men and four women with age of 69 years +/- 7.4 (range, 46-79 years). The maximum mean tumor diameter was 6.2 cm (range, 5.1-9.5 cm). RF ablation was performed under computed tomographic (CT) fluoroscopic guidance 1-2 weeks after chemoembolization. The primary endpoint of this study was survival. RESULTS: RF electrodes were placed in the planned sites, and RF ablation was completed witha planned protocol (technical success rate, 100%). enhancement was eradicated in all patients after 32 RF sessions. The primary and secondary technique effectiveness were 40% and 100%, respectively. There were two major complications in the 32 RF sessions (6%)-hepatic and diaphragm perforation. Local tumor progression developed in five of the 20 patients (25%) during tie of 30 months. The overall and recurrence-free survival rates were, respectively, 100% and at year, 62% and 28% at 3 years, and 41% and 14% at 5 years. The serum bilirubin level of 1.0 mg/dL (17.1 mu mol/L) less was a significantly better prognostic factor in the univariate analysis. CONCLUSIONS: This combination therapy may enhance survival in patients with HCCs larger than 5 cm.