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Keywords:
Abdomen, Liver, Interventional vascular, CT, Digital radiography, Ultrasound, Ablation procedures, Chemoembolisation, Treatment effects, Aneurysms, Cirrhosis, Radiation oncology in Developing Nations
Authors:
A. F. Mourad; Assiut/EG
DOI:
10.1594/ecr2014/C-0792
Methods and materials
Sixty patients with HCC on top of liver cirrhosis (40 males & 20 females),
their mean age 49 years (range 45 – 70 years),
were included in this 3 arms study.
The study was conducted between (August 2011 to February 2013) in the Upper Egypt cancer institute and Assiut University Hospital.
The protocol of the study has been approved by the ethical committee of research of Faculty of Medicine,
Assiut University,
and informed consent of the patients has been taken before the study.
Patients were selected on basis of clinical assessment,
liver function tests,
abdominal US and triphasic helical CT.
The criteria for entry in this study were as follow:
1- Single tumor,
size from 5 – 7 cm.
2- Child-Pough class A or B (25 patients class A,
and 35 patients class B).
3- No evidence of extra hepatic metastasis or ascites.
4- High serum alpha fetoprotein (AFP) ranging from 200 to 400ng/ml (mean 230)
5- No evidence of vascular invasion.
6- The tumor appears hypervascular at arterial phase of spiral CT.
7- The platelet count more than 50000 / mm3.
Patients were classified into 3 matched groups each included 20 patients.
Group 1 patients were treated by TACE.
In group 2,
RFA was done using RITA RF 1500X system USA,
and star burst XLi enhanced with tubing set(electrosurgical device) .
While,
in group 3 combined therapy (TACE - RFA) was performed (TACE was carried out first followed by RFA one week later).
Chemotherapy used in this study consisted of a mixture of Doxorubicin 50 mg dissolved in 10cc saline mixed with 8 cc lipidol,
5cc contrast media (ultravist 300ml/cc),
and gel foam.
Therapeutic efficacy was assessed and classified into good responders,
and poor responders on the basis of the size of the hypo attenuating non enhancing area according to Wang Y H et al [9].
Follow up from the time of treatment for a period of one year could be achieved hardly for all patients.
The incidence of recurrence,
development of new focal lesion,
presence of progressive disease or stable disease,
as well as,
survival in months was recorded for each patient.
Triphasic CT and US (with the same parameters as pretreatment scanning) were performed one month after the procedure,
6 months,
and one year later.
In addition,
serum AFP was estimated before and after ablation.