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Advanced Hepatocellular Carcinoma: Treatment with High-Intensity Focused Ultrasound Ablation Combined with Transcatheter Arterial Embolization¹

¹ From the Institute of Ultrasonic Engineering in Medicine and Clinical Center for Tumor Therapy of the 2nd Affiliated Hospital, Chongqing University of Medical Sciences, 1 Medical College Rd, Box 153, Chongqing 400016, China. Received June 20, 2003; revision requested August 29; final revision received August 5, 2004; accepted August 6. Supported by grants from the Ministry of Science and Technology of China (96–905-02–01) and the National Natural Science Foundation of China (39300125, 39630340, 39630340, 39670749, 39770841, 39770712, 30070217, 30171060). Address correspondence to F.W. (e-mail: mfengwu@yahoo.com).

PURPOSE: To evaluate ultrasonographically (US)-guided high-intensity focused ultrasound ablation combined with transcatheter arterial chemoembolization (TACE) in the treatment of stage IVA hepatocellular carcinoma (HCC).

MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained. From November 1998 to May 2000, 50 consecutive patients with stage IVA HCC (TNM classification, T4N0–1M0) were alternately enrolled in one of two treatment groups: group 1 (n = 26), in which TACE was performed alone, and group 2 (n = 24), in which transcutaneous ablation of HCC with high-intensity focused ultrasound was performed 2–4 weeks after TACE. The tumors were 4–14 cm in diameter (mean, 10.5 cm). Immediate therapeutic effects were assessed at follow-up with Doppler US and computed tomography or magnetic resonance imaging. All patients were followed up for 3–24 months (mean, 8 months) to observe long-term therapeutic effects and complications in both groups. Tumor reduction rates, median survival time, and cumulative survival rates in both groups were calculated by using the unpaired Student t test and Kaplan-Meier method.

RESULTS: No severe complication was observed after focused ultrasound ablation, and no unexpected side effects were noted after TACE. Follow-up images showed absence or reduction of blood supply in the lesions after focused ultrasound ablation when compared with blood supply after TACE alone. The median survival time was 11.3 months in group 2 and 4.0 months in group 1 (P = .004). The 6-month survival rate was 80.4%–85.4% in group 2 and 13.2% in group 1 (P = .002), and the 1-year survival rate was 42.9% and 0%, respectively. Median reductions in tumor size as a percentage of initial tumor volume at 1, 3, 6, and 12 months after treatment, respectively, were 28.6%, 35.0%, 50.0%, and 50.0% in group 2 and 4.8%, 7.7%, 10.0%, and 0% in group 1 (P < .01).

CONCLUSION: The combination of high-intensity focused ultrasound ablation and TACE is a promising approach in patients with advanced-stage HCC, but large-scale randomized clinical trials are necessary for confirmation.

© RSNA, 2005

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