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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 14, 2016; 22(6): 1935-1942
Published online Feb 14, 2016. doi: 10.3748/wjg.v22.i6.1935
Combined locoregional treatment of patients with hepatocellular carcinoma: State of the art
Roberto Iezzi, Maurizio Pompili, Alessandro Posa, Giuseppe Coppola, Antonio Gasbarrini, Lorenzo Bonomo
Roberto Iezzi, Alessandro Posa, Giuseppe Coppola, Lorenzo Bonomo, Department of Bioimaging, Institute of Radiology, “A. Gemelli” Hospital - Catholic University, 00168 Rome, Italy
Maurizio Pompili, Antonio Gasbarrini, Department of Internal Medicine, “A. Gemelli” Hospital - Catholic University, 00168 Rome, Italy
Author contributions: Iezzi R, Pompili M, Gasbarrini A and Bonomo L wrote the paper; Iezzi R, Pompili M, Posa A and Coppola G analyzed and interpreted data; Gasbarrini A and Bonomo L drafted the article; Iezzi R, Pompili M, Coppola G and Posa A made critical revisions; Iezzi R, Pompili M, Posa A, Coppola G, Gasbarrini A and Bonomo L approved the final version of the article.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Roberto Iezzi, MD, Department of Bioimaging, Institute of Radiology, “A. Gemelli” Hospital - Catholic University, L.go A Gemelli 8, 00168 Rome, Italy. roberto.iezzi@rm.unicatt.it
Telephone: +39-6-30154977 Fax: +39-6-35501928
Received: July 7, 2015
Peer-review started: July 8, 2015
First decision: September 29, 2015
Revised: December 9, 2015
Accepted: December 30, 2015
Article in press: December 30, 2015
Published online: February 14, 2016
Abstract

In recent years, a combination of intervention therapies has been widely applied in the treatment of hepatocellular carcinoma (HCC). One such combined strategy is based on the combination of the percutaneous approach, such as radiofrequency ablation (RFA), and the intra-arterial locoregional approach, such as trans-arterial chemoembolization (TACE). Several types of evidence have supported the feasibility and benefit of combined therapy, despite some studies reporting conflicting results and outcomes. The aim of this review was to explain the technical aspects of different combined treatments and to comprehensively analyze and compare the clinical efficacy and safety of this combined treatment option and monotherapy, either as TACE or RFA alone, in order to provide clinicians with an unbiased opinion and valuable information. Based on a literature review and our experience, combined treatment seems to be a safe and effective option in the treatment of patients with early/intermediate HCC when surgical resection is not feasible; furthermore, this approach provides better results than RFA and TACE alone for the treatment of large HCC, defined as those exceeding 3 cm in size. It can also expand the indication for RFA to previously contraindicated “complex cases”, with increased risk of thermal ablation related complications due to tumor location, or to “complex patients” with high bleeding risk.

Keywords: Hepatocellular carcinoma, Combined treatment, Chemoembolization, Ablation, Microwave

Core tip: A combination of imaging-guided local percutaneous and transarterial treatments of hepatocellular carcinoma is a promising strategy for tumors exceeding 3 cm in diameter and for multifocal tumors that are not amenable to resective surgery and for which the use of a single locoregional treatment option is often inadequate. In this paper, we assessed the indications, the technical aspects, the clinical efficacy and the safety of the different strategies of combining local non-surgical treatments for hepatocellular carcinoma complicating liver cirrhosis. The aim of this review is to explain the technical aspects of different combined treatments and to analyze and comprehensively compare the clinical efficacy and safety of the combined treatment and monotherapy, either chemoembolization or RF ablation alone, in order to provide clinicians with an unbiased opinion and valuable information.