Brief Articles
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Aug 7, 2009; 15(29): 3664-3669
Published online Aug 7, 2009. doi: 10.3748/wjg.15.3664
Sequential use of transarterial chemoembolization and percutaneous cryosurgery for hepatocellular carcinoma
Ke-Cheng Xu, Li-Zhi Niu, Qiang Zhou, Yi-Ze Hu, De-Hong Guo, Zheng-Ping Liu, Bing Lan, Feng Mu, Ying-Fei Li, Jian-Sheng Zuo
Ke-Cheng Xu, Li-Zhi Niu, Qiang Zhou, Bing Lan, Jian-Sheng Zuo, Cryosurgery Center for Cancer, Fuda Cancer Hospital, Guangzhou 510300, Guangdong Province, China
Yi-Ze Hu, Department of Hepato-biliary Surgery, Second Affiliated Hospital, Guangzhou Medical College, Guangzhou 510300, Guangdong Province, China
De-Hong Guo, Zheng-Ping Liu, Feng Mu, Oncology Department, Fuda Hospital, Guangzhou 510300, Guangdong Province, China
Ying-Fei Li, Department of Gastroenterology, Nanfang Hospital, Nanfang Medical University, Guangzhou 510300, Guangdong Province, China
Author contributions: Xu KC made the study plan, managed patient data and wrote the paper; Niu LZ and Hu YZ performed the cryosurgery procedures; Zhou Q performed transarterial chemoembolization; Guo DH, Liu ZP, Lan B and Mu F collected and provided the materials of patients; Li YF performed the statistical analysis; Zuo JS supervised the trial process.
Correspondence to: Ke-Cheng Xu, Professor, Cryosurgery Center for Cancer, Fuda Cancer Hospital, Guangzhou 510300, Guangdong Province, China. xukc@vip.163.com
Telephone: +86-20-34471288
Fax: +86-20-34471371
Received: March 23, 2009
Revised: June 30, 2009
Accepted: July 7, 2009
Published online: August 7, 2009
Abstract

AIM: To evaluate the efficacy of sequential use of transarterial chemoembolization (TACE) and percutaneous cryosurgery for unresectable hepatocellular carcinoma (HCC).

METHODS: Four hundred and twenty patients were enrolled in this study. The patients, who were considered to have unresectable tumors due to their location or size or comorbidity, were divided into sequential TACE-cryosurgery (sequential) group (n = 290) and cryosurgery alone (cryo-alone) group (n = 130). Patients in the sequential group tended to have larger tumors and a greater number of tumors than those in the cryo-alone group. Tumors larger than 10 cm in diameter were only seen in the sequential group. TACE was performed with the routine technique and percutaneous cryosurgery was conducted under the guidance of ultrasound 2-4 wk after TACE.

RESULTS: During a mean follow-up period of 42 ± 17 mo (range, 24-70 mo), the local recurrence rate at the ablated area was 17% for all patients, 11% and 23% for patients in sequential group and cryo-alone groups, respectively (P = 0.001). The overall 1-, 2-, 3-, 4- and 5-year survival rate was 72%, 57%, 47%, 39% and 31%, respectively. The 1- and 2-year survival rates (71% and 61%) in sequential group were similar to those (73% and 54%) in cryo-alone group (P = 0.69 and 0.147), while the 4- and 5-year survival rates were 49% and 39% in sequential group, higher than those (29% and 23%) in cryo-alone group (P = 0.001). Eighteen patients with large HCC (> 5 cm in diameter) survived for more than 5 years after sequential TACE while no patient with large HCC (> 5 cm in diameter) survived more than 5 years after cryosurgery. The overall complication rate was 24%, and the complication rates were 21% and 26% for the sequential and cryo-alone groups, respectively (P = 0.06). The incidence of hepatic bleeding was higher in cryo-alone group than in sequential group (P = 0.02). Liver crack only occurred in two patients of the cryo-alone group.

CONCLUSION: Pre-cryosurgical TACE can increase the cryoablation efficacy and decrease its adverse effects, especially bleeding. Sequential TACE and cryosurgery may be the better procedure for unresectable HCC, especially for large HCC.

Keywords: Hepatocellular carcinoma; Cryosurgery; Transarterial chemoembolization; Cryoablation; Treatment