Abstract No. 20: Hepatocellular carcinoma in the caudate lobe: radiofrequency ablation combined with chemoembolization under the real-time CT-fluoroscopic guidance

RFA was indicated for patients with 3 or fewer HCCs ( 3cm in diameter) ineligible for ultrasound (US)-guided RFA. From March 2009 to December 2010, single-session combined TACE and RFA was performed to treat 235 small HCCs ( 3cm in diameter) in 167 patients who had at least one HCC ineligible for US-guided RFA. The mean diameter of HCCs was 1.3 cm (range, 0.5 3.0 cm). TACE was performed using doxorubicin hydrochloride/iodized oil emulsion with gelatin sponge particle. Immediately after TACE, RFA was performed under guidance of fluoroscopy, US, cone-beam CT, or their combination. Initial tumor response (complete remission of the treated HCC on post-procedural and/or 1-month follow up CT), complications (major and minor), local recurrence, and remote recurrence were evaluated. Results: Initial tumor response was achieved in 234 (99.6%) of 235 HCCs. During the follow up period of 1-25 months (median, 11 months), local recurrence was observed in 3 (1.8%) of 166 patients (1.3%, 3 of 234 HCCs) and remote recurrence developed in 49 (29.5%) of 166 patients. Forty-eight complications (10 major and 38 minor) occurred in 44 (26.3%) of 167 patients. Ten major complications included 2 liver abscess (one requiring antibiotics and the other leading to septic pneumonia causing death), 2 heaptic encephalopathy requiring enema, and one each of fistula between the right hepatic artery and bile duct requiring embolization, skin burn due to electrode insulation injury requiring skin excision and repair, atrial fibrillation due to hypotension requiring cardioversion and ICU care for 12 hours, intrahepatic bile duct stricture due to thermal injury requiring percutaneous drainage, colon perforation requiring antibiotics, and hemothorax due to transpleural access requiring chest tube insertion. Conclusion: Single-session combined TACE and RFA can be an effective treatment for small HCCs ineligible for US-guided RFA, with an acceptable complication rate.