Radiofrequency Ablation Combined with Chemoembolization in Hepatocellular Carcinoma: Treatment Response Based on Tumor Size and Morphology

PURPOSE To evaluate local therapeutic efficacy of radiofrequency (RF) ablation after chemoembolization for hepatocellular carcinoma (HCC) based on tumor size and morphology. MATERIALS AND METHODS Sixty-four patients underwent RF ablation under ultrasonographic or real-time computed tomographic (CT) fluoroscopic guidance within 2 weeks after chemoembolization. One hundred eight lesions were treated. Sixty-five lesions were small (<3 cm), 32 were intermediate in size (3.1–5 cm), and 11 were large (5.1–12 cm). Seventy-four of the HCCs were nodular lesions and the other 34 were nonnodular (multinodular and infiltrative) lesions. Response to treatment was evaluated by dynamic enhanced CT and magnetic resonance imaging. Tumor necrosis was considered to be complete when no foci of enhancement were seen within the tumor and at its periphery. RESULTS Complete necrosis was achieved in all lesions regardless of tumor size or morphology. There have been no local recurrences in small and intermediate-sized lesions regardless of tumor morphology during a mean follow-up of 12.5 months. In large HCCs, nodular lesions showed no recurrence, but two of six of nonnodular lesions recurred beyond the thermal lesions created around the tumor. The estimated 1-year survival rate was 98.0% in all patients. CONCLUSIONS This combined therapy has a therapeutic effect on small and intermediate-sized HCCs regardless of tumor morphology and is a promising treatment option for large nodular lesions. Control of large nonnodular lesions is still a challenging problem. To evaluate local therapeutic efficacy of radiofrequency (RF) ablation after chemoembolization for hepatocellular carcinoma (HCC) based on tumor size and morphology. Sixty-four patients underwent RF ablation under ultrasonographic or real-time computed tomographic (CT) fluoroscopic guidance within 2 weeks after chemoembolization. One hundred eight lesions were treated. Sixty-five lesions were small (<3 cm), 32 were intermediate in size (3.1–5 cm), and 11 were large (5.1–12 cm). Seventy-four of the HCCs were nodular lesions and the other 34 were nonnodular (multinodular and infiltrative) lesions. Response to treatment was evaluated by dynamic enhanced CT and magnetic resonance imaging. Tumor necrosis was considered to be complete when no foci of enhancement were seen within the tumor and at its periphery. Complete necrosis was achieved in all lesions regardless of tumor size or morphology. There have been no local recurrences in small and intermediate-sized lesions regardless of tumor morphology during a mean follow-up of 12.5 months. In large HCCs, nodular lesions showed no recurrence, but two of six of nonnodular lesions recurred beyond the thermal lesions created around the tumor. The estimated 1-year survival rate was 98.0% in all patients. This combined therapy has a therapeutic effect on small and intermediate-sized HCCs regardless of tumor morphology and is a promising treatment option for large nodular lesions. Control of large nonnodular lesions is still a challenging problem.