Combined Transarterial Chemoembolization and Percutaneous Ablation: A Single-Center Experience

Background: Hepatocellular carcinoma (HCC) is a significant health concern in the Middle-East countries. Various management options are implemented to increase the survival rate in liver cancer patients with variable success rates. In this study, we aimed to evaluate the impact of combined transarterial chemoembolization (TACE) and percutaneous thermal ablation with either radiofrequency ablation (RFA) or microwave ablation (MWA) on the survival rate of patients with 2–5 cm HCC managed at King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia. Methods: We retrospectively evaluated 17 patients; 12 males (70%) and five females (30%), with a median age of 74 years. Ten patients (59%) had Child–Pugh A score, while seven (31%) had Child–Pugh B score. The HCC sizes ranged from 2 to 5 cm on the widest dimension. Six lesions (35%) were treated with lipiodol-TACE and 11 lesions (65%) were managed with drug-eluting bead-TACE. RFA was used in ablating 13 lesions (76%) and four lesions (24%) were treated with MWA. We followed those patients by computed tomography/magnetic resonance imaging for local recurrence in 3, 6, 12, and 24 months. The survival rate was assessed in 6, 12, and 24 months. Results: After successful combined TACE and imaging-guided percutaneous ablation, no recurrence was noted over 3 and 6 months. However, the recurrence rate was 28% and 50% at 12 and 24 months, respectively. Hundred percent survival rate was accomplished in 6 and 12 months, while we achieved 86% in 24 months, which is similar to a large-scale meta-analysis. However, seven patients have been lost during follow-up. Conclusion: A meta-analysis of combined TACE and percutaneous ablation demonstrates the superiority of this method for decreasing local recurrence and increasing survival rate in patients with HCC measuring 3–5 cm. Our experience supports the recommendations of using combined embolic and ablative therapy in this group of patients.

Publication History

Article published online:
11 May 2021