Published online Feb 14, 2016. doi: 10.3748/wjg.v22.i6.1935
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
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.
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.