Learning objectives
It has been well-known that combination of the two of RFA,
PEI,
and TACE produces a synergistic effect.
The combination of TACE and PEI,
TACE and RFA,
or PEI and RFA is more effective than each of the monotherapies in preventing incomplete necrosis,
especially in advanced disease or when tumors are in close proximity to large vessels or vital structures.
So we illustrate technique,
advantage,
disadvantage,
role,
and limitation of each combination therapy.
Background
1.
Understanding and rationale of combination therapy for treatment of HCC
Liver cancer is the fifth most common cancer in the world and its incidence is increasing worldwide.
But only about 30% of patients can benefit from curative therapies such as resection or liver transplantation due to poor liver function,
as well as multiplicity of tumors.
Therefore,
non-surgical locoregional therapies have been used worldwide,
such as transcatheter arterial chemoembolization(TACE), percutaneous ethanol injection(PEI) and radiofrequency ablation(RFA).
They are minimally invasive options that can achieve the successful...
Findings and procedure details
3.
Principle,
technique,
advantage and disadvantage of each combination therapy
3.1.
TACE plus PEI
Principle and technique: TACE performed followed by PEI.
PEI performedat 7 to 10 days afterTACE because recovery of side effects of TACE without recanalization of tumor vesselswhen PEIwill be performed.
The Principle ofTACE plus PEI is increasement of ethanol diffusion secondary to tumor necrosis and disruption of intratumoral septa produced by TACE before thePEI.
In addition,
embolization may reduce ethanol wash-out.
Advantage: (Fig.
2) Significantly improve thesurvival rate in patients with...
Conclusion
Combination therapy is more effective than each of monotherapies,
and each combination therapy has own inherent advantage,
disadvantage,
role,
and limitation.
References
1.
Lai EC,
Fan ST,
Lo CM,
Chu KM,
Liu CL,
Wong J: Hepatic resection for hepatocellular carcinoma: an audit of 343 patients.
Ann Surg 1995; 221: 291-8.
2.
Lo CM,
Ngan H,
Tso WK,
Liu CL,
Lam CM,
Poon RT,
et al.: Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma.
Hepatology 2002; 35: 1164-71.
3.
Dettmer A,
Kirchhoff TD,
Gebel M,
Zender L,
Malek NP,
et al: Combination of repeated single-session percutaneous ethanol injection and transarterial chemoembolisation compared to repeated single-session...