Introduction: We aimed to assess the safety and effectiveness of combining transarterial chemoembolization with percutaneous thermal ablation (using radiofrequency or microwave ablation) in treating solitary hepatocellular carcinoma tumors measuring between 2 to 4.5 cm, located subdiaphragmatically, subcapsularly, or perivascularly.
Method: We retrospectively analyzed eighteen patients (15 males, mean age of 68.6 ± 8.64 [range: 34-75] years) who underwent transarterial chemoembolization combined with concurrent percutaneous radiofrequency ablation (n = 5) or microwave ablation (n = 13) for hepatocellular carcinoma situated in areas with a high risk of recurrence (subdiaphragmatic, subcapsular, or perivascular) between 2012 and 2019. We examined tumor size and location, procedural success rate, safety, local efficacy (assessed by imaging at 1 month post-treatment), local tumor response (at 3 months post-treatment), local tumor progression, intrahepatic distant recurrence, overall survival, and complications.
Results: Tumor sizes ranged from 20 to 45 mm (mean: 32.5 ± 8.42 mm). Hepatocellular carcinoma diameters were between 2 to 3 cm in 8 patients and 3.1 to 4.5 cm in 10 patients. The technical success rate was 100%, with no life-threatening complications. At enhanced imaging after 1 month, complete necrosis was achieved in all cases; at 3 months, a complete response was observed in all patients. Over a mean follow-up period of 24 ± 11.3 months, tumor progression occurred in 10 patients (55.5%). Three patients (16.6%) exhibited local tumor response, and 4 patients (22.2%) experienced distant recurrences in the untreated liver. The mean durations for local tumor progression and intrahepatic distant recurrence were 10 months and 29.5 months, respectively. Survival rates were 100% at 1 year, 75% at 3 years, and 49% at 5 years.
Conclusion: Combining transarterial chemoembolization with simultaneous percutaneous thermal ablation appears to be a safe, feasible, and effective approach in improving local control rates for solitary hepatocellular carcinoma tumors ranging from 2 to 4.5 cm in high-risk recurrence regions.