Combination Percutaneous and Intraarterial Therapy for the Treatment of Hepatocellular Carcinoma: A Review

ABSTRACT

Transcatheter arterial chemoembolization (TACE) and percutaneous ablation therapies have been shown to provide effective therapy and afford survival prolongation for patients with unresectable hepatocellular carcinoma (HCC). Both treatments, however, have inherent limitations that restrict their benefit; TACE is not a curative therapy and ablation efficacy is significantly limited by lesion size. Current treatment strategies aim to combine intraarterial and percutaneous liver-directed therapies synergistically to improve tumor response, and by extension improve patient survival. This article reviews the current literature on combination treatments, and examines the circumstances in which therapeutic combinations would improve tumor response and patient survival.

Hepatocellular carcinoma - chemoembolization - radiofrequency ablation - cryoablation - microwave

REFERENCES

• 1 Yu M C, Yuan J M, Govindarajan S, Ross R K. Epidemiology of hepatocellular carcinoma.  Can J Gastroenterol. 2000;  14(8) 703-709
• 2 Seong J, Keum K C, Han K H et al.. Combined transcatheter arterial chemoembolization and local radiotherapy of unresectable hepatocellular carcinoma.  Int J Radiat Oncol Biol Phys. 1999;  43(2) 393-397
• 3 El-Serag H B, Mason A C. Risk factors for the rising primary liver cancer in the United States.  Arch Intern Med. 2000;  160(21) 3227-3230
• 4 Vogl T J, Trapp M, Schroeder H et al.. Transarterial chemoembolization for hepatocellular carcinoma: volumetric and morphologic CT criteria for assessment of prognosis and therapeutic success-results from a liver transplantation center.  Radiology. 2000;  214(2) 349-357
• 5 De Sanctis J T, Goldberg S N, Mueller P R. Percutaneous treatment of hepatic neoplasms: a review of current techniques.  Cardiovasc Intervent Radiol. 1998;  21(4) 273-296
• 6 Bolondi L, Sofia S, Siringo S et al.. Surveillance programme of cirrhotic patients for early diagnosis and treatment of hepatocellular carcinoma: a cost effectiveness analysis.  Gut. 2001;  48(2) 251-259
• 7 Sugioka A, Tsuzuki T, Kanai T. Postresection prognosis of patients with hepatocellular carcinoma.  Surgery. 1993;  113(6) 612-618
• 8 Llovet J M, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival.  Hepatology. 2003;  37(2) 429-442
• 9 Lo C M, Ngan H, Tso W K et al.. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma.  Hepatology. 2002;  35(5) 1164-1171
• 10 Cammà C, Schepis F, Orlando A et al.. Transarterial chemoembolization for unresectable hepatocellular carcinoma: meta-analysis of randomized controlled trials.  Radiology. 2002;  224(1) 47-54
• 11 Carr B I. Hepatic artery chemoembolization for advanced stage HCC: experience of 650 patients.  Hepatogastroenterology. 2002;  49(43) 79-86
• 12 Herber S, Schneider J, Brecher B et al.. [TACE: therapy of the HCC before liver transplantation—experiences].  Rofo. 2005;  177(5) 681-690
• 13 Georgiades C S, Hong K, Geschwind J F. Pre- and postoperative clinical care of patients undergoing interventional oncology procedures: a comprehensive approach to preventing and mitigating complications.  Tech Vasc Interv Radiol. 2006;  9(3) 113-124
• 14 Georgiades C S, Hong K, Geschwind J F. Radiofrequency ablation and chemoembolization for hepatocellular carcinoma.  Cancer J. 2008;  14(2) 117-122
• 15 Shibata T, Isoda H, Hirokawa Y, Arizono S, Shimada K, Togashi K. Small hepatocellular carcinoma: is radiofrequency ablation combined with transcatheter arterial chemoembolization more effective than radiofrequency ablation alone for treatment?.  Radiology. 2009;  252(3) 905-913
• 16 Veltri A, Moretto P, Doriguzzi A, Pagano E, Carrara G, Gandini G. Radiofrequency thermal ablation (RFA) after transarterial chemoembolization (TACE) as a combined therapy for unresectable non-early hepatocellular carcinoma (HCC).  Eur Radiol. 2006;  16(3) 661-669
• 17 Gasparini D, Sponza M, Marzio A, Zanardi R, Bazzocchi M, Cemal Y. Combined treatment, TACE and RF ablation, in HCC: preliminary results.  Radiol Med (Torino). 2002;  104(5–6) 412-420
• 18 Wang Y H, Liu J F, Li F et al.. Radiofrequency ablation combined with transarterial chemoembolization for unresectable primary liver cancer.  Chin Med J (Engl). 2009;  122(8) 889-894
• 19 Bloomston M, Binitie O, Fraiji E et al.. Transcatheter arterial chemoembolization with or without radiofrequency ablation in the management of patients with advanced hepatic malignancy.  Am Surg. 2002;  68(9) 827-831
• 20 Lu M D, Chen J W, Xie X Y et al.. Hepatocellular carcinoma: US-guided percutaneous microwave coagulation therapy.  Radiology. 2001;  221(1) 167-172
• 21 Martin R C, Scoggins C R, McMasters K M. Safety and efficacy of microwave ablation of hepatic tumors: a prospective review of a 5-year experience.  Ann Surg Oncol. 2010;  17(1) 171-178
• 22 Yang W Z, Jiang N, Huang N, Huang J Y, Zheng Q B, Shen Q. Combined therapy with transcatheter arterial chemoembolization and percutaneous microwave coagulation for small hepatocellular carcinoma.  World J Gastroenterol. 2009;  15(6) 748-752
• 23 Seki T, Tamai T, Nakagawa T et al.. Combination therapy with transcatheter arterial chemoembolization and percutaneous microwave coagulation therapy for hepatocellular carcinoma.  Cancer. 2000;  89(6) 1245-1251
• 24 Xu K C, Niu L Z, Zhou Q et al.. Sequential use of transarterial chemoembolization and percutaneous cryosurgery for hepatocellular carcinoma.  World J Gastroenterol. 2009;  15(29) 3664-3669
• 25 Clavien P A, Kang K J, Selzner N, Morse M A, Suhocki P V. Cryosurgery after chemoembolization for hepatocellular carcinoma in patients with cirrhosis.  J Gastrointest Surg. 2002;  6(1) 95-101