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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
Conclusion
DISCUSSION:-
HCC is the third most important cause of cancer related mortality worldwide [10].
Locoregional treatment options such as TACE and RFA are minimally invasive treatment options that may individually or in combination address the pertinent issue of successful tumor targeting and preservation of liver function [10].
The current study is three arms one,
planned to compare TACE,
RFA and combined therapy with matched patients groups.
One year follow up of all patients could be achieved hardly and with great effort.
Reporting the response; the recurrence ( RD ) ,
the development of new focal lesion ,
the progression ( PD ) and stable disease ( SD ),
in addition the overall survival and the recurrence free percentage in the three groups.
The percentage of good response was 70 % in TACE group which is in accordance to the data of many other reports [11-15].
Meanwhile,
it was 60 % in RFA group that was in the agreement with other study [16].
On the other hand,
it was 90 % in combined therapy group,
and this going with data of other authors [17-19].
Local recurrence (RD) and new focal lesion was observed in 2 patients of TACE group and 3 patients of RFA group,
while neither recurrence nor new focal lesions was detected in the combined therapy group.
It was noticed that recurrence developed in patients who needed 2nd session either of TACE or RFA group.
Regarding patients who demonstrated poor response in the three therapeutic modalities,
5 patients developed progression of the disease (PD) and 1 patient showed stable disease (SD) in TACE group.
Meanwhile,
6 patients developed (PD) and 2 patients showed (SD) in RFA group.
In combined therapy group,
one of the two patients who demonstrated poor response showed stable disease,
while the other died.
In TACE group the overall survival was 75 %,
while the recurrence free survival was 60 % and this is going with other published data [20].
On the other hand,
the overall survival in RFA group was 90 %,
while the free recurrence survival was 45 % and this is going near the data of other reports [21-23].
Alternatively,
in combined therapy group the overall survival was 95 %,
while the free recurrence survival was 90 %,
and this is in accordance to the data of other authors [18,
24].
From the previous data we can conclude that combined therapy is superior regarding the good response,
overall survival,
and the free recurrence survival to either TACE or RFA alone.
This have been explained by Zhen wei-peng et al [19] that occlusion of hepatic arterial flow by means of TACE before RF ablation reduces the
cooling effect of hepatic blood flow on thermal coagulation.
Furthermore,
lipidol and gelatin sponge particles used in TACE reduce the portal flow around the tumor by filling the peripheral portal veins around the tumor with lipidol via multiple arterio portal communications,
thus the necrotic area induced by RFA may be increased,
in addition to,
the positive thermal impact on the anticancer effect of the retained chemotherapeutic agent.
while TACE therapy is relatively superior to RFA,
one considering the percentage of good response and the recurrence free survival that is in accordance to other studies [28-30] which reported that RFA is 100% effective in lesions not more than 3cm,
while TACE is more suitable for larger lesions.
Regarding the alpha-fetoprotein,
it was decreased gradually near to the normal levels in all patients developed good response in the three groups,
and this is going with data reported by other authors [15,27].
In fact,
that currant study has three limitations.
The first is small sample size relative to other studies.
The second is short period of follow up,
which is one year only,
and of course we cannot predict the result data of each group on longer follow up.
Thirdly the study was not blindly randomized to avoid selection bias during evaluation of patients.