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      Radiofrequency Ablation Combined with Transcatheter Arterial Chemoembolization for the Treatment of Single Hepatocellular Carcinoma of 2 to 5 cm in Diameter: Comparison with Surgical Resection

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          Abstract

          Objective

          To compare the effectiveness of radiofrequency ablation (RFA) combined with transcatheter arterial chemoembolization (TACE) with surgical resection in patients with a single hepatocellular carcinoma (HCC) ranging from 2 to 5 cm.

          Materials and Methods

          The study participants were enrolled over a period of 29 months and were comprised of 37 patients in a combined therapy group and 47 patients in a surgical resection group. RFA was performed the day after TACE, and surgical resection was performed by open laparotomy. The two groups were compared with respect to the length of hospital stay, rates of major complication, and rates of recurrence-free and overall survival.

          Results

          Major complications occurred more frequently in the surgical resection group (14.9%) than in the combined therapy group (2.7%). However, there was no statistical significance ( p = 0.059). The rates of recurrence-free survival at 1, 2, 3 and 4 years were similar between the combined therapy group (89.2%, 75.2%, 69.4% and 69.4%, respectively) and the surgical resection group (81.8%, 68.5%, 68.5% and 65%, respectively) ( p = 0.7962, log-rank test). The overall survival rates at 1, 2, 3 and 4 years were also similar between groups (97.3%, 86.5%, 78.4% and 78.4%, respectively, in the combined therapy group, and 95.7%, 89.4%, 84.3% and 80.3%, respectively, in the surgical resection group) ( p = 0.6321, log-rank test).

          Conclusion

          When compared with surgical resection for the treatment of a single HCC ranging from 2 to 5 cm, RFA combined with TACE shows similar results in terms of recurrence-free and overall survival rates.

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          Most cited references32

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          Hepatocellular carcinoma: radio-frequency ablation of medium and large lesions.

          To study local therapeutic efficacy, side effects, and complications of radio-frequency (RF) ablation in the treatment of medium and large hepatocellular carcinoma (HCC) lesions in patients with cirrhosis or chronic hepatitis. One-hundred fourteen patients who were under conscious sedation or general anesthesia had 126 HCCs greater than 3.0 cm in diameter treated with RF by using an internally cooled electrode. Eighty tumors were medium (3.1-5.0 cm), and 46 were large (5.1-9.5 cm). The mean diameter for all tumors was 5.4 cm. At imaging, 75 tumors were considered noninfiltrating, and 51 were considered infiltrating. Complete necrosis was attained in 60 lesions (47.6%), nearly complete (90%-99%) necrosis in 40 lesions (31.7%), and partial (50%-89%) necrosis in the remaining 26 lesions (20.6%). Medium and/or noninfiltrating tumors were treated successfully significantly more often than large and/or infiltrating tumors. Two major complications (death, hemorrhage requiring laparotomy) and five minor complications (self-limited hemorrhage, persistent pain) were observed. The single death was due to a break in sterile technique rather than to the RF procedure itself. RF ablation appears to be an effective, safe, and relatively simple procedure for the treatment of medium and large HCCs.
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            The minimal ablative margin of radiofrequency ablation of hepatocellular carcinoma (> 2 and < 5 cm) needed to prevent local tumor progression: 3D quantitative assessment using CT image fusion.

            The aim of this study was to elucidate the minimal ablative margin for percutaneous radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) (> 2 and or = 0, > or = 1, > or = 2, and > or = 3 mm, respectively. An insufficient ablative margin was the sole significant factor associated with local tumor progression. When the thickness of the ablative margin is evaluated by CT image fusion, a margin of 3 mm or more appears to be associated with a lower rate of local tumor progression after percutaneous RFA of HCC.
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              Surgery for small liver cancers.

              During the last 16 years, we have resected small hepatocellular carcinomas (HCCs) measuring 5 cm or less from 362 patients, 266 of whom also had liver cirrhosis. The operative and hospital mortality rate were 1.7% and 1.9%, respectively. These showed a gradual decrease year by year in parallel with reduction of intraoperative blood loss achieved by the selective vascular occlusion technique and Pringle method. In 1989, 87% of hepatectomy patients were discharged without the need for whole blood transfusion, and 5-year survival was 43.7%. Tumor size, number of tumors, intrahepatic metastasis, vascular invasion, and capsular invasion were significant prognostic factors. Edmondson grade and the operative procedure employed were significantly related to outcome. Our standard policy for selection of operative procedures and perioperative care is described, and the selection of treatment modalities is discussed.
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                Author and article information

                Journal
                Korean J Radiol
                Korean J Radiol
                KJR
                Korean Journal of Radiology
                The Korean Society of Radiology
                1229-6929
                2005-8330
                Jul-Aug 2013
                17 July 2013
                : 14
                : 4
                : 626-635
                Affiliations
                [1 ]Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun 519-763, Korea.
                [2 ]Department of Radiology, Chonnam National University Medical School, Gwangju 501-757, Korea.
                [3 ]Center for Aging and Geriatrics, Chonnam National University Medical School, Gwangju 501-757, Korea.
                [4 ]Department of Internal Medicine, Chonnam National University Medical School, Gwangju 501-757, Korea.
                [5 ]Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun 519-763, Korea.
                Author notes
                Corresponding author: Sang Soo Shin, MD, Department of Radiology, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju 501-757, Korea. Tel: (8262) 220-5882, Fax: (8262) 226-4380, kjradsss@ 123456dreamwiz.com
                Article
                10.3348/kjr.2013.14.4.626
                3725357
                23901320
                215d45c4-5d45-4f67-88db-a25455664d1d
                Copyright © 2013 The Korean Society of Radiology

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 04 October 2012
                : 06 February 2013
                Categories
                Intervention
                Original Article

                Radiology & Imaging
                radiofrequency ablation,hepatocellular carcinoma,transcatheter arterial chemoembolization,combination therapy,hepatectomy

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