Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2020; 12(8): 355-368
Published online Aug 27, 2020. doi: 10.4240/wjgs.v12.i8.355
Drug-eluting beads transarterial chemoembolization sequentially combined with radiofrequency ablation in the treatment of untreated and recurrent hepatocellular carcinoma
Yan Zhang, Mei-Wu Zhang, Xiao-Xiang Fan, Da-Feng Mao, Quan-Hua Ding, Lu-Hui Zhuang, Shu-Yi Lv
Yan Zhang, Mei-Wu Zhang, Xiao-Xiang Fan, Da-Feng Mao, Lu-Hui Zhuang, Shu-Yi Lv, Department of Interventional Therapy, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo 315010, Zhejiang Province, China
Yan Zhang, Mei-Wu Zhang, Xiao-Xiang Fan, Da-Feng Mao, Lu-Hui Zhuang, Shu-Yi Lv, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo 315010, Zhejiang Province, China
Yan Zhang, Mei-Wu Zhang, Xiao-Xiang Fan, Da-Feng Mao, Lu-Hui Zhuang, Shu-Yi Lv, Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Ningbo 315010, Zhejiang Province, China
Quan-Hua Ding, Department of Gastroenterology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo 315010, Zhejiang Province, China
Author contributions: Zhang MW was the guarantor and designed the study; Zhang Y, Zhang MW, Fan XX, Mao DF, and Ding QH designed the research; Zhang Y, Zhang MW, Fan XX, Mao DF, Ding QH, Zhuang LH, and Lv SY performed the research; Fan XX, Mao DF, and Ding QH contributed new analytic tools; Fan XX, Mao DF, Zhuang LH, and Lv SY analyzed data; Zhang Y, Zhang MW, Fan XX, Mao DF, and Ding QH wrote the paper and revised the article critically for important intellectual content.
Supported by Medical and Health Science and Technology Foundation of Zhejiang Province, No. 2017KY590 and No. 2019KY175; and Ningbo Clinical Research Center for Digestive System Tumors, No. 2019A21003.
Institutional review board statement: The study was approved by the ethics committee of Hwa Mei Hospital, University of Chinese Academy of Sciences.
Informed consent statement: All patients gave informed consent.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement, and the manuscript was prepared and revised according to the STROBE Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Mei-Wu Zhang, MD, Associate Chief Physician, Department of Interventional Therapy, Hwa Mei Hospital, University of Chinese Academy of Sciences, No. 41 Xibei Street, Haishu District, Ningbo 315010, Zhejiang Province, China. zhangmeiwu@163.com
Received: April 7, 2020
Peer-review started: April 7, 2020
First decision: May 5, 2020
Revised: May 8, 2020
Accepted: July 19, 2020
Article in press: July 19, 2020
Published online: August 27, 2020
ARTICLE HIGHLIGHTS
Research background

Ultrasound-guided radiofrequency ablation (RFA) is one of the most effective treatments for early hepatocellular carcinoma (HCC). However, due to the limitation of local tumor control ability, RFA is difficult to completely cover tumors with a diameter of more than 3 cm. Transarterial chemoembolization (TACE) can significantly reduce the volume of hepatic carcinoma. Hence the combined use of TACE and RFA can obtain a larger ablation coverage volume.

Research motivation

Drug-eluting beads TACE (DEB-TACE) has the advantages of sustained slow release, maintaining a high local concentration, and reducing the incidence of adverse drug reactions compared to traditional TACE. DEB-TACE combined with ultrasound-guided RFA therapy has strong anti-cancer effects and little side effects, but there are fewer related long-term studies in clinical setting.

Research objectives

The aim of our study was to explore the possible benefits of DEB-TACE combined with RFA by analyzing the liver function and clinical efficacy of patients with primary HCC. It is hopeful to help the management of HCC.

Research methods

Seventy-six patients with primary HCC who underwent DEB-TACE combined with ultrasound-guided RFA were recruited. Among them, 40 patients with untreated HCC were defined as Group A, 36 patients with recurrent HCC were defined as Group B, and 40 patients with untreated HCC who were treated with surgery were defined as Group C. All patients underwent serological examination and recorded alpha-fetoprotein and liver function. Liver function tests were performed at the 1st week and 1st month after treatment to assess liver damage. Efficacy was assessed at the 3rd, 6th, and 9th month after treatment. All patients were followed up for 3 years and their overall survival (OS), disease-free survival (DFS) were calculated.

Research results

After 3 mo of treatment, the effective rate of Group A and C was similar. Among them, group A has less damage to liver function during treatment. The OS and DFS were similar in the two groups. It indicated that the efficacy of DEA-TACE combined with ultrasound-guided RFA in the treatment of primary HCC is comparable to traditional surgical treatment. It has faster recovery, and less damage to liver function during treatment. The OS of Group B were similar to Group A, and the DFS of Group B were lower than Group A. It indicated that the efficacy of DEA-TACE combined with ultrasound-guided RFA in the treatment of recurrent HCC is positive, with fewer complications, and it can prolong the survival time.

Research conclusions

The efficacy of DEA-TACE combined with ultrasound-guided RFA in the treatment of primary HCC is comparable to that of traditional surgical treatment. Moreover, it has less bleeding, faster recovery, and less damage to liver function during treatment. Its efficacy in the treatment of recurrent HCC is positive, with fewer complications, and it can prolong the survival time of patients.

Research perspectives

DEB-TACE combined with ultrasound-guided RFA in the treatment of recurrent HCC has a positive effect, fewer complications, and can prolong the survival time of patients. However, this study is still a single-center study, and the sample size is limited. This study will perform a larger sample and more detailed research with big data services to get more accurate conclusions.