Radiofrequency ablation and chemoembolization for hepatocellular carcinoma.

PURPOSE: To provide an up-to-date review of the technique, efficacy, safety and clinical applications for radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).
METHODS: A thorough review of the literature was performed as related to RFA and TACE for the treatment of HCC. We mixed these findings with our own extensive research and clinical experience on this subject by drawing from a pool of more than 1000 patients treated with both modalities.
RESULTS: TACE has been shown with the work of Llovet, Camma, and Lo to provide a significant survival benefit for patients with unresectable HCC. The former showed a 1-, 2-, and 3-year survival at 57%, 31%, and 26% in the treatment group vs. 32%, 11%, and 3% in the supportive treatment alone group, respectively. Repeatedly, RFA has been shown to be very effective in the treatment of small (<or=3 cm) HCC lesions with a complete response rate of about 90%. Studies have shown that RFA may be equivalent to surgical resection in this subgroup of patients. For both modalities, patient selection and proper technique are important in minimizing the possible complications associated with them, which rarely includes liver failure, abscess formation, and hemorrhage. DISCUSSION: RFA and TACE have both been shown to provide a survival benefit for patients with unresectable HCC. More recent studies have paired these modalities with surgical resection with favorable results. Refined technique, improvements in technology, and research on better-targeted chemotherapy will likely result in further improved survival benefit. Additionally, the scope of this treatment is broadening to include resectable patients, patients awaiting liver transplantation, and, in combination with other systemic (bevacizumab, sorafenib, etc) or locoregional (RFA-TACE combination, RFA-resection etc) treatments.