联合TACE和RFA治疗大肝癌

WorldJGastroenterol.2013Jul14;

19(26):4192-9.doi:10.3748/wjg.v19.i26.4192.Transcatheterarterialchemoembolizationfollowedbyimmediateradiofrequencyablationforlargesolitaryhepatocellularcarcinomas.WangZJ,WangMQ,DuanF,SongP,LiuFY,ChangZF,WangY,YanJY,LiK.DepartmentofInterventionalRadiology,PLAGeneralHospital,Beijing100853,China.AIM:Toassessthetechnicalsafetyandefficacyoftranscatheterarterialchemoembolization(TACE)combinedwithimmediateradiofrequencyablation(RFA)forlargehepatocellularcarcinomas(HCC)(maximumdiameter≥5cm).METHODS:Individuallesionsin18patientswithHCCs(meanmaximumdiameter:7.5cm;

range:5.1-15.5cm)weretreatedbyTACEcombinedwithpercutaneousRFAbetweenJanuary2010andJune2012.AllofthepatientshadpreviouslyundergoneonetofourcyclesofTACEtreatment.Regularimagingandlaboratorytestswereperformedtoevaluatetherateoftechnicalsuccess,technique-relatedcomplications,local-regionaltumorresponses,recurrence-freesurvivaltimeandsurvivalrateaftertreatment.RESULTS:Technicalsuccesswasachievedforall18visibleHCCs.Completeresponse(CR)wasobservedin17cases,andpartialresponsewasobservedin1case1moafterintervention.TheCRratewas94.4%.Localtumorsweremainlycharacterizedbycoagulativenecrosis.Duringfollow-up(2-29mo),themeanrecurrence-freesurvivaltimewas16.8±4.0moin17casesofCR.Theestimatedoverallsurvivalrateat6,12,and18mowas100%.Nomajorcomplicationswereobserved.Levelsofalanineaminotransferase(ALT)andaspartateaminotransferase(AST)inthebloodof17patientstransientlyincreasedonthethirddayaftertreatment(ALT200.4±63.4U/Lvs24.7±9.3U/L,P0.05;

AST228.1±25.4U/Lvs32.7±6.8U/L,P0.05).Severepainoccurredinthreepatients,whichwascontrolledwithmorphineandfentanyl.CONCLUSION:TACEcombinedwithimmediateRFAisasafeandeffectivetreatmentforlargesolitaryHCCs.Severepainisamajorsideeffect,butcanbecontrolledbymorphine.PMCID:PMC3710422