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Vascular and Interventional Radiology |
1 From the Department of Radiology and Diagnostic Imaging (C.M.P., G.B., A.B., V.A., S.P.) and the Department of Endocrine, Metabolic, and Digestive Diseases (Z.R.), Regina Apostolorum Hospital, Via St Francesco 50, 00041 Albano Laziale, Rome, Italy; the Diagnostic Radiology Service, St Anna Hospital, Como, Italy (P.C., B.C.); and the Gastroenterology Unit, St Donato Hospital, Arezzo, Italy (F.M.). From the 1999 RSNA scientific assembly. Received February 9, 2000; revision requested March 24; final revision received August 30; accepted October 2. Address correspondence to C.M.P. (e-mail: cmpacel@kat.it).
PURPOSE: To determine the potential long-term effectiveness of laser thermal ablation (LTA) followed by transcatheter arterial chemoembolization (TACE) in the percutaneous ablation of large hepatocellular carcinoma (HCC).
MATERIALS AND METHODS: Thirty large HCCs 3.5–9.6 cm in diameter (mean diameter, 5.2 cm) and 15 small HCCs 0.8–3.0 cm (mean diameter, 1.9 cm) were treated with ultrasonographically guided LTA with TACE and with LTA alone, respectively, in 30 patients: 19 with a solitary large HCC, and 11 with one to three additional synchronous small HCCs. A 1.064-µm neodymium yttrium-aluminium-garnet (Nd-YAG) laser at a power of 5.0 W was coupled with one to four quartz optic fibers that were advanced through 21-gauge needles. Segmental TACE was performed 30–90 days after LTA. All lesions were evaluated for change in size at computed tomography (CT), 
-fetoprotein (AFP) levels, recurrence rates, and cumulative survival rates.
RESULTS: No major complications occurred in 127 LTA sessions. CT showed complete tumor necrosis in 27 (90%) of 30 large HCCs. Twenty-eight patients were followed up for 6–41 months (mean, 17.1 months). In 25 patients, all lesions appeared stable or smaller at CT. AFP levels decreased to the normal range in all patients with high pretreatment values. The 1-, 2-, and 3-year local recurrence rate was 7% in large HCCs. Complete tumor necrosis was achieved in all 15 (100%) small HCCs; none of them recurred locally. The 1-, 2-, and 3-year cumulative survival rates were 92%, 68%, and 40%, respectively.
CONCLUSION: LTA followed by TACE is an effective palliative therapy in treating large HCCs.
Index terms: Lasers, interstitial therapy, 761.1299 • Liver, interventional procedures, 761.1299 • Liver neoplasms, 761.323 • Liver neoplasms, chemotherapeutic embolization, 761.1266, 761.323 • Liver neoplasms, therapy, 761.1266, 761.1299, 761.323
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