Background/Aim s: Surgical resection, transplantation, and radiofrequency ablation (RFA) are generally accepted as amenable treatments for small hepatocellular carcinoma (HCC). Recently drug-eluting beads (DEB) which had several treatment advantages were introduced for transarterial chemoembolization (TACE). The aim of this study was to evaluate feasibility and safety of DEB-TACE compared with RFA for the treatment of single small HCC.
Methods In this pilot non-randomized trial, we assessed retrospective data of 40 patients who underwent DEB-TACE (n=21) or RFA (n=19) for single small (≤3 centimeter in greatest dimension) HCC. The primary outcomes were tumor response and time to recurrence. The secondary outcome was treatment-related complications.
Results Complete response rate to DEB-TACE and RFA after first follow-up assessment was 90.5% and 94.7%, respectively (P=1.000). During mean follow-up of 87.6 months (95% confidence interval: 74.4-102), 7 patients experienced local recurrence. The 6- and 12-month cumulative local recurrence rate was 5.0% and 21.8% in DEB-TACE vs. 11.1% and 17.0% in RFA group (P=0.877). A total 14 distant intrahepatic recurrences were developed and 12- and 24-month cumulative distant intrahepatic recurrence rate was 20.6% and 42.7% in DEBTACE vs. 17.2% and 36.3% in RFA group (P=0.844). Two patients experienced gangrenous cholecystitis after DEB-TACE requiring cholecystectomy as treatment-related adverse event.
Conclusions Tumor response and recurrence rate after single session of DEB-TACE or RFA were similar. DEB-TACE could be applied selectively in patients with a single small HCC if the other therapeutic modality is unfeasible.
Citations
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Incidence and Risk Factors of Acute Ischemic Cholecystitis after Transarterial Chemoembolization: Correlation with Cone Beam CT Findings Jong Yeong Kim, Jung Suk Oh, Ho Jong Chun, Su Ho Kim Journal of the Korean Society of Radiology.2024;[Epub] CrossRef
Drug-Eluting Bead Transarterial Chemoembolization Versus Radiofrequency Ablation as an Initial Treatment of Single Small (≤ 3 cm) Hepatocellular Carcinoma Somin Lee, Yong Yeon Jeong, Byung Chan Lee, Sang Soo Shin, Suk Hee Heo, Hyoung Ook Kim, Chan Park, Won Gi Jeong Journal of Korean Medical Science.2023;[Epub] CrossRef
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Tumor size is one of the most important factors for decision of therapeutic plan and prognosis of hepatocellular carcinoma
(HCC). If the diagnosis of HCC is made earlier in its small size, the prognosis is better. However the diagnosis of small HCC
is not easy because small HCC lacks the typical clinical and radiologic feature. We experienced two cases of small HCC less than
1 cm that was confirmed after first treatment.
Radiofrequency ablation (RFA) is the preferred method of local ablation for patients with small (<3 cm sized)
hepatocellular carcinoma (HCC) when surgical resection cannot be applied. If RFA procedure is sufficiently completed, it
provides lower local tumor recurrence, and longer overall as well as disease-free survival. We experienced a case of early
stage HCC which recurred at 2 months after successful RFA procedure, and rapidly metastasized to lung and brain.
Hyun Young Woo, Jin Dong Kim, Jung Hyun Kwon, Si Hyun Bae, Jong Young Choi, Seung Kew Yoon, Sung Eun Rha, Jae Young Byun, Ho Jong Chun, Byung Gil Choi, Hae Kyu Lee, Young Kyoung You, Dong Gu Kim
Journal of the Korean Liver Cancer Study Group. 2009;9(1):45-48. Published online June 30, 2009
Liver transplantation is curative therapy for hepatocellular carcinoma especially if ,within Milan criteria, 4 year survival
and recurrence-free survival was reported to be 85% and 92%, respectively. Herein we report a patient who experience rapid
recurrence following living donor liver transplantation (LDLT) for hepatocellular carcinoma within Milan criteria. A 52
year-old-men patient with known liver cirrhosis associated with hepatitis B virus was admitted for the treatment of
hepatocellular carcinoma (HCC). Abdominal CT revealed two nodules less than 3 cm in right hepatic lobe. After single
session of transcatheter arterial chemoembolization (TACE), the patient underwent LDLT. After seven months following
transplantation, recurrent HCC was detected on transplanted liver with concurrent metastatic nodule in lung. Although TACE
and metastsectomy were performed for recurrent intrahepatic mass and lung metastasis, recurrent HCC showed rapid
progression and patient died of progressive tumor after 10 months following LDLT.
Hyun Young Woo, Jin Dong Kim, Jung Hyun Kwon, Chan Ran You, Jeong Won Jang, Si Hyun Bae, Jong Young Choi, Se Hyun Cho, Seung Kew Yoon, Dong Hoon Lee, Ho Jong Chun, Byung Gil Choi, Chul Seung Kay
Journal of the Korean Liver Cancer Study Group. 2008;8(1):124-127. Published online June 30, 2008
A 45-year-old man was admitted for the treatment of hepatocellular carcinoma (HCC). He was diagnosed
hepatitis B carrier 16 years ago and has not done a routine check. Abdominal CT showed a diffuse infiltrative
HCC involving right hepatic lobe with portal vein tumor thrombosis (PVTT) involving right portal vein and
proximal portion of left portal vein umbilical portion. With concurrent transcatheter arterial chemotherapy (TAC),
helical tomotherapy for portal vein thrombosis was done. With these treatments, main tumor and PVTT was
decreased in size markedly and no stain in hepatic angiogram. Due to repeated TAC, hepatic arterial stenosis
occurred and TAC was stopped. 3 months after, recurrent tumor was detected in MRI. Radiofrequency ablation
followed by High Intensity Focused Ultrasound (HIFU) was done for this recurrent mass. No viable mass was
shown in the follow up MRI done 6 months after HIFU.