Clinical Application of Transcatheter Arterial Chemoembolization Combined with Synchronous C-arm Cone-Beam CT Guided Radiofrequency Ablation in treatment of Large Hepatocellular Carcinoma

  • Wang, Zhi-Jun (Department of Interventional Radiology, PLA General Hospital) ;
  • Wang, Mao-Qiang (Department of Interventional Radiology, PLA General Hospital) ;
  • Duan, Feng (Department of Interventional Radiology, PLA General Hospital) ;
  • Song, Peng (Department of Interventional Radiology, PLA General Hospital) ;
  • Liu, Feng-Yong (Department of Interventional Radiology, PLA General Hospital) ;
  • Wang, Yan (Department of Interventional Radiology, PLA General Hospital) ;
  • Yan, Jie-Yu (Department of Interventional Radiology, PLA General Hospital) ;
  • Li, Kai (Department of Interventional Radiology, PLA General Hospital) ;
  • Yuan, Kai (Department of Interventional Radiology, PLA General Hospital)
  • Published : 2013.03.30


Objective: This work aimed to evaluate the safety and clinical efficacy of transcatheter arterial chemoembolization (TACE) combined with c-arm cone-beam CT guided synchronous radiofrequency ablation (RFA) in treatment of large hepatocellular carcinoma (HCC). Methods: 21 patients with large HCC were studied from January 2010 to March 2012. TACE combined with synchronous C-arm cone-beam CT guided RFA were performed on a total of 25 lesions. Conventional imaging examination (CEUS, enhanced CT or MRI) and AFP detection were regularly conducted to evaluate the technical success rate of combined treatment, complications, treatment response, time without disease recurrence and survival rate. Results: The technical success rate of combined treatment was 100%, without any significant complication. After 1 month, there were 19 cases with complete response and 2 cases with partial response, with an complete response rate of 90.4% (19/21) and a clinical effective rate of 100% (21/21). The complete response rates of single nodular lesions (100%, 17/17) was significantly higher than that of multiple nodular lesions (50%, 2/4) (P<0. 05). During 2 to 28 months of follow-up, in 19 cases with complete response, the average time without disease recurrence was $10.8{\pm}6$ months. The total survival rates of 6, 12 and 18 months in 21 patients were 100%, respectively. Conclusion: TACE combined with synchronous C-arm CT guided RFA is safe and effective for treatment of large HCC. The treatment efficacy for single nodular lesion is better than that for multiple nodular lesions.


  1. Bruix J, Sherman M, Llovet JM, et al (2001). Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol, 35, 421-30.
  2. Fan WZ, Yang JY, Lü MD, et al (2011). Transcatheter arterial chemoembolization plus percutaneous thermal ablation in large hepatocellular carcinoma: clinical observation of efficacy and predictors of prognostic factors. Zhonghua Yi Xue Za Zhi, 91, 2190-4.
  3. Forner A, Llovet JM, Bruix J (2012). Hepatocellular carcinoma. Lancet, 379, 1245-55.
  4. Gadaleta C, Catino A, Ranieri G, et al (2009). Single-step therapy -- feasibility and safety of simultaneous transarterial chemoembolization and radiofrequency ablation for hepatic malignancies. In Vivo, 23, 813-20.
  5. Georgiades CS, Hong K, Geschwind JF, et al (2008). Radiofrequency ablation and chemoembolization for hepatocellular carcinoma. Cancer J, 14, 117-22.
  6. Head HW, Dodd GD 3rd, Bao A, et al (2010). Combination radiofrequency ablation and intravenous radiolabeled liposomal Doxorubicin: imaging and quantification of increased drug delivery to tumors. Radiology, 255, 405-14.
  7. Kang SG, Yoon CJ, Jeong SH, et al (2009). Single-session combined therapy with chemoembolization and radiofrequency ablation in hepatocellular carcinoma less than or equal to 5 cm: a preliminary study. J Vasc Interv Radiol, 20, 1570-7.
  8. Kim MH, Choi MS, Choi YS, et al (2006). Clinical features of liver abscess developed after radiofrequency ablation and transarterial chemoembolization for hepatocellular carcinoma. Korean J Hepatol, 12, 55-64.
  9. Lee MW, Kim YJ, Park SW, et al (2009). Percutaneous radiofrequency ablation of small hepatocellular carcinoma invisible on both ultrasonography and unenhanced CT: a preliminary study of combined treatment with transarterial chemoembolisation. Br J Radiol, 82, 908-15.
  10. Lee MW, Kim YJ, Park SW, et al (2011). Biplane fluoroscopyguided radiofrequency ablation combined with chemoembolisation for hepatocellular carcinoma: initial experience. Br J Radiol, 84, 691-7.
  11. Marín-Hargreaves G, Azoulay D, Bismuth H (2003). Hepatocellular carcinoma: surgical indications and results. Crit Rev Oncol Hematol, 47, 13-27.
  12. Miyayama S, Yamashiro M, Okuda M, et al (2010). Chemoembolization for the treatment of large hepatocellular carcinoma. J Vasc Interv Radiol, 21, 1226-34.
  13. Dhanasekaran R, Kooby DA, Staley CA, et al (2010). Comparison of conventional transarterial chemoembolization (TACE) and chemoembolization with doxorubicin drug eluting beads (DEB) for unresectable hepatocelluar carcinoma (HCC). J Surg Oncol, 101, 476-80.
  14. Shimada K, Sakamoto Y, Esaki M, et al (2008). Role of a hepatectomy for the treatment of large hepatocellular carcinomas measuring 10 cm or larger in diameter. Langenbecks Arch Surg, 393, 521-6.
  15. Shiraishi R, Yamasaki T, Saeki I, et al (2008). Pilot study of combination therapy with transcatheter arterial infusion chemotherapy using iodized oil and percutaneous radiofrequency ablation during occlusion of hepatic blood flow for hepatocellular carcinoma. Am J Clin Oncol, 31, 311-6.
  16. Takaki H, Yamakado K, Nakatsuka A, et al (2007). Radiofrequency ablation combined with chemoembolization for the treatment of hepatocellular carcinomas 5 cm or smaller: risk factors for local tumor progression. J Vasc Interv Radiol, 18, 856-61.
  17. Takaki H, Yamakado K, Uraki J, et al (2009). Radiofrequency ablation combined with chemoembolization for the treatment of hepatocellular carcinomas larger than 5 cm. J Vasc Interv Radiol, 20, 217-24.
  18. Veltri A, Moretto P, Doriguzzi A, et al (2006). Radiofrequency thermal ablation (RFA) after transarterial chemoembolization (TACE) as a combined therapy for unresectable non-early hepatocellular carcinoma (HCC). Eur Radiol, 16, 661-9.
  19. Wang W, Shi J, Xie WF (2010). Transarterial chemoembolization in combination with percutaneous ablation therapy in unresectable hepatocellular carcinoma: a meta-analysis. Liver Int, 30, 741-9.
  20. Yamakado K, Nakatsuka A, Ohmori S, et al (2002). Radiofrequency ablation combined with chemoembolization in hepatocellular carcinoma: treatment response based on tumor size and morphology. J Vasc Interv Radiol, 13, 1225-32.
  21. Yamakado K, Nakatsuka A, Takaki H, et al (2010). Subphrenic versus nonsubphrenic hepatocellular carcinoma: combined therapy with chemoembolization and radiofrequency ablation. AJR Am J Roentgenol, 194, 530-5.
  22. Zangos S, Eichler K, Balzer JO, et al (2007). Large-sized hepatocellular carcinoma (HCC): a neoadjuvant treatment protocol with repetitive transarterial chemoembolization (TACE) before percutaneous MR-guided laser-induced thermotherapy (LITT). Eur Radiol, 17, 553-63.

Cited by

  1. Interventional sonography of the liver and kidneys vol.53, pp.11, 2013,
  2. Safety and Efficacy of Sequential Transcatheter Arterial Chemoembolization and Portal Vein Embolization prior to Major Hepatectomy for Patients with HCC vol.15, pp.2, 2014,
  3. Retrospective Evaluation of Discrepancies between Radiological and Pathological Size of Hepatocellular Carcinoma Masses vol.15, pp.21, 2014,
  4. Drainage Alone or Combined with Anti-tumor Therapy for Treatment of Obstructive Jaundice Caused by Recurrence and Metastasis after Primary Tumor Resection vol.15, pp.6, 2014,
  5. 3D CACT-assisted Radiofrequency Ablation Following Transarterial Chemoembolization for Hepatocellular Carcinoma: Early Experience vol.16, pp.17, 2015,
  6. Impact of 3D Rotational Angiography on Liver Embolization Procedures: Review of Technique and Applications vol.38, pp.3, 2015,
  7. Transarterial Therapies for Hepatocellular Carcinoma: a Comprehensive Review with Current Updates and Future Directions vol.17, pp.2, 2016,
  8. Early Stage Hepatocellular Carcinomas Not Feasible for Ultrasound-Guided Radiofrequency Ablation: Comparison of Transarterial Chemoembolization Alone and Combined Therapy with Transarterial Chemoembolization and Radiofrequency Ablation vol.39, pp.3, 2016,
  9. Combined transcatheter arterial chemoembolization and radiofrequency ablation in single-session for solitary hepatocellular carcinoma larger than 7 cm pp.17437555, 2017,
  10. Transcatheter arterial chemoembolization combined with simultaneous DynaCT-guided radiofrequency ablation in the treatment of solitary large hepatocellular carcinoma pp.1826-6983, 2018,
  11. Clinical efficacy of chemoembolization with simultaneous radiofrequency ablation for treatment of adrenal metastases from hepatocellular carcinoma vol.18, pp.1, 2018,