Clinical effect of sequential therapy with transarterial chemoembolization and bipolar-needle radiofrequency ablation in treatment of hepatocellular carcinoma in high-risk locations

Objective To investigate the clinical effect of sequential therapy with transarterial chemoembolization ( TACE) and bipolar-needle radiofrequency ablation ( RFA) in the treatment of hepatocellular carcinoma ( HCC) in high-risk locations. Methods A total of 35 previously untreated patients with HCC in high-risk locations who visited Shengjing Hospital of China Medical University from January 2014 to June 2015 were enrolled. They were given TACE for 15-60 days, followed by CT-guided bipolar-needle FRA. The patients were followed up for 2-36 months after surgery, and the clinical outcomes were evaluated. The t-test was used for comparison of continuous data between groups, and the chi-square test or Fisher's exact test was used for comparison of categorical data between groups. The Kaplan-Meier method was used for survival analysis. Results A total of 35 HCC patients with 40 lesions were enrolled and given the sequential therapy with TACE and bipolar-needle RFA, and the technical success rate was 100%. The lesions with a maximum diameter of ≤3 cm achieved a complete ablation rate of 100% ( 28/28) , and those with a maximum diameter of > 3 cm achieved a complete ablation rate of66. 7% ( 8/12) ; there was a significant difference between these two groups ( P = 0. 005) . The patients were followed up to June 2017; the median survival time was 27. 6 months, and the 1-and 2-year survival rates were 94. 3% and 65. 7%, respectively. The lesions close to the capsule had a higher complete ablation rate than those in other locations ( 95% vs 85%, P > 0. 05) , as well as a lower incidence rate of complications ( 15% vs 35%, P > 0. 05) . There was a significant difference in mean ablation time between the lesions with > 50% lipiodol deposition and those with < 50% lipiodol deposition ( 24. 2 ± 6. 7 min vs 30. 1 ± 10. 2 min, t = 2. 163, P = 0. 037) . No patients experienced serious complications; mild complications included slight subcapsular hemorrhage in three patients, slight abdominal hemorrhage in one patient, subcutaneous hematoma in one patient, mild pneumothorax with slight abdominal hemorrhage in one patient, mild pneumothorax in two patients, and mild hemothorax in two patients, and all these complications were relieved after conservative treatment. Conclusion Sequential therapy with TACE and CT-guided bipolar-needle RFA is safe and effective in patients with HCC in high-risk locations, and may have a better therapeutic effect on subcapsular lesions than on the lesions in other high-risk locations.