Combined Transarterial Chemoembolization with Microwave Ablation versus Microwave Alone for Treatment of Medium Sized Hepatocellular Carcinoma | Bentham Science
Generic placeholder image

Current Cancer Drug Targets

Editor-in-Chief

ISSN (Print): 1568-0096
ISSN (Online): 1873-5576

Research Article

Combined Transarterial Chemoembolization with Microwave Ablation versus Microwave Alone for Treatment of Medium Sized Hepatocellular Carcinoma

Author(s): Waleed El-Agawy, Sara Ahmed El-Ganainy, Magdy Abd Almawgoud Gad, Sherief Abd-Elsalam*, Wessam Abd Alltaif Mostafa* and Mohammed El-Sayed El-Shewi

Volume 22, Issue 1, 2022

Published on: 20 January, 2022

Page: [77 - 85] Pages: 9

DOI: 10.2174/1568009622666220117094146

Price: $65

Open Access Journals Promotions 2
Abstract

Background & Aims: Hepatocellular carcinoma (HCC) is the fifth most common cancer and the second leading cause of cancer-related deaths. The only definitive treatment for both HCC and cirrhosis is liver transplantation, but long wait times in some regions and a relatively fixed number of donor organs negatively impact access to liver transplantation. The aim of the work was to evaluate and compare the short outcome of patients with medium-sized HCC who will undergo percutaneous microwave ablation (MWA) alone and in combination with TACE.

Methods: This prospective study included 40 patients with medium-sized HCC lesions who were classified into two groups; Group A that included twenty patients treated by TACE followed by percutaneous MWA after 2 weeks and group B that included twenty patients treated by 2 sessions of percutaneous MWA with 2 weeks interval. Full history taking, clinical examination, laboratory investigation, abdominal ultrasonography and abdominal tri-phasic computed tomography (CT) with contrast were obtained from the two groups. Laboratory and radiological follow up of the cases were done at 1 and 3 months after the treatment.

Results: There was no statistically significant difference in the sociodemographic criteria, laboratory measurement and clinical criteria between the cases in the two study groups before initiation of treatment. The response was slightly better in the combined treatment group, but it did not show a statistically significant difference. The incidence of complications was higher in the MWA group.

Conclusion: Hepatocellular carcinoma is a common complication of HCV related cirrhosis. Association of TACE-MWA led to better response rates than MWA with fewer complications.

Keywords: Microwave ablation, transarterial chemoembolization, hepatocellular carcinoma, mortality, complications, recurrence.

Graphical Abstract
[1]
Dimitroulis, D.; Damaskos, C.; Valsami, S.; Davakis, S.; Garmpis, N.; Spartalis, E.; Athanasiou, A.; Moris, D.; Sakellariou, S.; Kykalos, S.; Tsourouflis, G.; Garmpi, A.; Delladetsima, I.; Kontzoglou, K.; Kouraklis, G. From diagnosis to treatment of hepatocellular carcinoma: An epidemic problem for both developed and developing world. World J. Gastroenterol., 2017, 23(29), 5282-5294.
[http://dx.doi.org/10.3748/wjg.v23.i29.5282] [PMID: 28839428]
[2]
El-Serag, H.B. Epidemiology of viral hepatitis and hepatocellular carcinoma. Gastroenterology, 2012, 142(6), 1264-1273.
[http://dx.doi.org/10.1053/j.gastro.2011.12.061]
[3]
Elgamal, S.; Ghafar, A.A.; Ghoneem, E.; Elshaer, M.; Alrefai, H.; Elemshaty, W. Characterization of patients with hepatocellular carcinoma on the way for early detection: one center experience. Egypt. J. Intern. Med., 2018, 30(4), 231-238.
[http://dx.doi.org/10.4103/ejim.ejim_29_18]
[4]
Abdelaziz, A.O.; Nabeel, M.M.; Elbaz, T.M.; Shousha, H.I.; Hassan, E.M.; Mahmoud, S.H.; Rashed, N.A.; Ibrahim, M.M.; Abdelmaksoud, A.H. Microwave ablation versus transarterial chemoembolization in large hepatocellular carcinoma: Prospective analysis. Scand. J. Gastroenterol., 2015, 50(4), 479-484.
[http://dx.doi.org/10.3109/00365521.2014.1003397] [PMID: 25592058]
[5]
Kuang, M.; Xie, X-Y.; Huang, C.; Wang, Y.; Lin, M-X.; Xu, Z-F.; Liu, G.J.; Lu, M.D. Long-term outcome of percutaneous ablation in very early-stage hepatocellular carcinoma. J. Gastrointest. Surg., 2011, 15(12), 2165-2171.
[http://dx.doi.org/10.1007/s11605-011-1716-2] [PMID: 21972056]
[6]
Abdelaziz, A.; Elbaz, T.; Shousha, H.I.; Mahmoud, S.; Ibrahim, M.; Abdelmaksoud, A.; Nabeel, M. Efficacy and survival analysis of percutaneous radiofrequency versus microwave ablation for hepatocellular carcinoma: An Egyptian multidisciplinary clinic experience. Surg. Endosc., 2014, 28(12), 3429-3434.
[http://dx.doi.org/10.1007/s00464-014-3617-4] [PMID: 24935203]
[7]
Abdelaziz, A.O.; Elbaz, T.M.; Shousha, H.I.; Ibrahim, M.M.; Rahman El-Shazli, M.A.; Abdelmaksoud, A.H.; Aziz, O.A.; Zaki, H.A.; Elattar, I.A.; Nabeel, M.M. Survival and prognostic factors for hepatocellular carcinoma: An Egyptian multidisciplinary clinic experience. Asian Pac. J. Cancer Prev., 2014, 15(9), 3915-3920.
[http://dx.doi.org/10.7314/APJCP.2014.15.9.3915] [PMID: 24935574]
[8]
Tanaka, M.; Ando, E.; Simose, S.; Hori, M.; Kuraoka, K.; Ohno, M.; Yutani, S.; Harada, K.; Sata, M. Radiofrequency ablation combined with transarterial chemoembolization for intermediate hepatocellular carcinoma. Hepatol. Res., 2014, 44(2), 194-200.
[http://dx.doi.org/10.1111/hepr.12100] [PMID: 23521520]
[9]
Ginsburg, M.; Zivin, S.P.; Wroblewski, K.; Doshi, T.; Vasnani, R.J.; Van Ha, T.G. Comparison of combination therapies in the management of hepatocellular carcinoma: Transarterial chemoembolization with radiofrequency ablation versus microwave ablation. J. Vasc. Interv. Radiol., 2015, 26(3), 330-341.
[http://dx.doi.org/10.1016/j.jvir.2014.10.047] [PMID: 25534635]
[10]
Bruix, J.; Sherman, M. Management of hepatocellular carcinoma: An update. Hepatology, 2011, 53(3), 1020-1022.
[http://dx.doi.org/10.1002/hep.24199] [PMID: 21374666]
[11]
Minami, Y.; Kudo, M.; Chung, H.; Kawasaki, T.; Yagyu, Y.; Shimono, T.; Shiozaki, H. Contrast harmonic sonography-guided radiofrequency ablation therapy versus B-mode sonography in hepatocellular carcinoma: prospective randomized controlled trial. AJR Am. J. Roentgenol., 2007, 188(2), 489-494.
[http://dx.doi.org/10.2214/AJR.05.1286] [PMID: 17242259]
[12]
Ma, Y.; Zhang, X.; Li, X.; Zhang, L.; Su, H.; Zhan, C. Value of computed tomography and magnetic resonance imaging in diagnosis and differential diagnosis of small hepatocellular carcinoma. Nan Fang Yi Ke Da Xue Xue Bao, 2008, 28(12), 2235-2238.
[13]
Abdelaziz, A.O.; Abdelmaksoud, A.H.; Nabeel, M.M.; Shousha, H.I.; Cordie, A.A.; Mahmoud, ShH.; Medhat, E.; Omran, D.; Elbaz, T.M. Transarterial chemoembolization combined with either radiofrequency or microwave ablation in management of hepatocellular carcinoma. Asian Pac. J. Cancer Prev., 2017, 18(1), 189-194.
[PMID: 28240516]
[14]
EI-Edel, RH; Tawfik, GA; Noreldin, RI; El-Jaky, MA; Eisaa, DA Evaluation of serum Midkine as a novel marker in hepatocellular carcinomas. Menoufia Med. J., 2018, 31(3), 1094.
[15]
Shaheen, K.Y.; Abdel-Mageed, A.I.; Safwat, E.; AlBreedy, A.M. The value of serum midkine level in diagnosis of hepatocellular carcinoma. Int. J. Hepatol., 2015, 2015, 146389.
[http://dx.doi.org/10.1155/2015/146389]
[16]
Abozaid, S.R.; Elshamy, M.H.; Alazim, A.A.; Elhawari, S.A. Microwave ablation and/or transcatheter arterial chemo-embolization in the treatment of hepatocellular carcinoma. AJIED, 2020, 10(4), 407-416.
[http://dx.doi.org/10.21608/aeji.2020.25284.1054]
[17]
Smolock, A.R.; Cristescu, M.M.; Hinshaw, A.; Woo, K.M.; Wells, S.A.; Ziemlewicz, T.J.; Lubner, M.G.; Dalvie, P.S.; Louis Hinshaw, J.; Brace, C.L.; Ozkan, O.S.; Lee, F.T., Jr; Laeseke, P. Combination transarterial chemoembolization and microwave ablation improves local tumor control for 3- to 5-cm hepatocellular carcinoma when compared with transarterial chemoembolization alone. Abdom. Radiol. (N.Y.), 2018, 43(9), 2497-2504.
[http://dx.doi.org/10.1007/s00261-018-1464-9] [PMID: 29450606]
[18]
Xu, L.F.; Sun, H.L.; Chen, Y.T.; Ni, J.Y.; Chen, D.; Luo, J.H.; Zhou, J.X.; Hu, R.M.; Tan, Q.Y. Large primary hepatocellular carcinoma: Transarterial chemoembolization monotherapy versus combined transarterial chemoembolization-percutaneous microwave coagulation therapy. J. Gastroenterol. Hepatol., 2013, 28(3), 456-463.
[http://dx.doi.org/10.1111/jgh.12088] [PMID: 23216261]
[19]
Mazure, N.M.; Chauvet, C.; Bois-Joyeux, B.; Bernard, M-A.; Nacer-Chérif, H.; Danan, J-L. Repression of α-fetoprotein gene expression under hypoxic conditions in human hepatoma cells: Characterization of a negative hypoxia response element that mediates opposite effects of hypoxia inducible factor-1 and c-Myc. Cancer Res., 2002, 62(4), 1158-1165.
[PMID: 11861398]
[20]
Memon, K.; Kulik, L.; Lewandowski, R.J.; Wang, E.; Ryu, R.K.; Riaz, A.; Nikolaidis, P.; Miller, F.H.; Yaghmai, V.; Baker, T.; Abecassis, M.; Benson, A.B., III; Mulcahy, M.F.; Omary, R.A.; Salem, R. Alpha-fetoprotein response correlates with EASL response and survival in solitary hepatocellular carcinoma treated with transarterial therapies: A subgroup analysis. J. Hepatol., 2012, 56(5), 1112-1120.
[http://dx.doi.org/10.1016/j.jhep.2011.11.020] [PMID: 22245905]
[21]
He, C.; Zhang, X.; Li, C.; Peng, W.; Wen, T-F.; Yan, L-N.; Yang, J.; Lu, W. Changes of alpha-fetoprotein levels could predict recurrent hepatocellular carcinoma survival after trans-arterial chemoembolization. Oncotarget, 2017, 8(49), 85599-85611.
[http://dx.doi.org/10.18632/oncotarget.20343] [PMID: 29156744]
[22]
Li, W.; Man, W.; Guo, H.; Yang, P. Clinical study of transcatheter arterial chemoembolization combined with microwave ablation in the treatment of advanced hepatocellular carcinoma. J. Cancer Res. Ther., 2016, 12(7)(Suppl.), C217-C220.
[http://dx.doi.org/10.4103/0973-1482.200598] [PMID: 28230020]
[23]
Goldberg, S.N.; Saldinger, P.F.; Gazelle, G.S.; Huertas, J.C.; Stuart, K.E.; Jacobs, T.; Kruskal, J.B. Percutaneous tumor ablation: Increased necrosis with combined radio-frequency ablation and intratumoral doxorubicin injection in a rat breast tumor model. Radiology, 2001, 220(2), 420-427.
[http://dx.doi.org/10.1148/radiology.220.2.r01au44420] [PMID: 11477246]
[24]
Mostafa, E.M.; Ganguli, S.; Faintuch, S.; Mertyna, P.; Goldberg, S.N. Optimal strategies for combining transcatheter arterial chemoembolization and radiofrequency ablation in rabbit VX2 hepatic tumors. J. Vasc. Interv. Radiol., 2008, 19(12), 1740-1748.
[http://dx.doi.org/10.1016/j.jvir.2008.08.028] [PMID: 18951042]
[25]
Guo, J.; Wang, S.; Han, Y.; Jia, Z.; Wang, R. Effects of transarterial chemoembolization on the immunological function of patients with hepatocellular carcinoma. Oncol. Lett., 2021, 22(1), 554.
[http://dx.doi.org/10.3892/ol.2021.12815] [PMID: 34084221]
[26]
Liu, H-C.; Shan, E-B.; Zhou, L.; Jin, H.; Cui, P-Y.; Tan, Y.; Lu, Y.M. Combination of percutaneous radiofrequency ablation with transarterial chemoembolization for hepatocellular carcinoma: observation of clinical effects. Chin. J. Cancer Res., 2014, 26(4), 471-477.
[PMID: 25232222]
[27]
Bharadwaz, A.; Bak-Fredslund, K.P.; Villadsen, G.E.; Nielsen, J.E.; Simonsen, K.; Sandahl, T.D.; Grønbæk, H.; Nielsen, D.T. Combination of radiofrequency ablation with transarterial chemoembolization for treatment of hepatocellular carcinoma: Experience from a Danish tertiary liver center. Acta Radiol., 2016, 57(7), 844-851.
[http://dx.doi.org/10.1177/0284185115603246] [PMID: 26342009]
[28]
Xu, C.; Lv, P-H.; Huang, X-E.; Wang, S-X.; Sun, L.; Wang, F-A. Efficacy of transarterial chemoembolization combined with radiofrequency ablation in treatment of hepatocellular carcinoma. Asian Pac. J. Cancer Prev., 2015, 16(14), 6159-6162.
[http://dx.doi.org/10.7314/APJCP.2015.16.14.6159] [PMID: 26320512]
[29]
Chen, Q-W.; Ying, H-F.; Gao, S.; Shen, Y-H.; Meng, Z-Q.; Chen, H.; Chen, Z.; Teng, W.J. Radiofrequency ablation plus chemoembolization versus radiofrequency ablation alone for hepatocellular carcinoma: A systematic review and meta-analysis. Clin. Res. Hepatol. Gastroenterol., 2016, 40(3), 309-314.
[http://dx.doi.org/10.1016/j.clinre.2015.07.008] [PMID: 26428660]
[30]
Liao, M.; Huang, J.; Zhang, T.; Wu, H. Transarterial chemoembolization in combination with local therapies for hepatocellular carcinoma: A meta-analysis. PLoS One, 2013, 8(7), e68453.
[http://dx.doi.org/10.1371/journal.pone.0068453] [PMID: 23844203]
[31]
Clark, T.W.I. Complications of hepatic chemoembolization. Semin. Intervent. Radiol., 2006, 23(2), 119-125.
[32]
Bertot, L.C.; Sato, M.; Tateishi, R.; Yoshida, H.; Koike, K. Mortality and complication rates of percutaneous ablative techniques for the treatment of liver tumors: A systematic review. Eur. Radiol., 2011, 21(12), 2584-2596.
[http://dx.doi.org/10.1007/s00330-011-2222-3] [PMID: 21858539]
[33]
Poggi, G.; Tosoratti, N.; Montagna, B.; Picchi, C. Microwave ablation of hepatocellular carcinoma. World J. Hepatol., 2015, 7(25), 2578-2589.
[http://dx.doi.org/10.4254/wjh.v7.i25.2578] [PMID: 26557950]
[34]
Liu, C.; Liang, P.; Liu, F.; Wang, Y.; Li, X.; Han, Z.; Liu, C. MWA combined with TACE as a combined therapy for unresectable large-sized hepotocellular carcinoma. Int. J. Hyperthermia, 2011, 27(7), 654-662.
[http://dx.doi.org/10.3109/02656736.2011.605099] [PMID: 21966941]
[35]
Negm, O.; Abou Saif, S.; El Gharib, M.; Yousef, M.; Abd-Elsalam, S. Role of low-molecular-weight heparins in prevention of thromboembolic complication after transarterial chemoembolization in hepatocellular carcinoma. Eur. J. Gastroenterol. Hepatol., 2017, 29(3), 317-321.
[http://dx.doi.org/10.1097/MEG.0000000000000790] [PMID: 27893491]
[36]
Watany, M.; Badawi, R.; Elkhalawany, W.; Abd-Elsalam, S. Study of Dickkopf-1 (DKK-1) Gene Expression in Hepatocellular Carcinoma Patients. J. Clin. Diagn. Res., 2017, 11(2), OC32-OC34.
[http://dx.doi.org/10.7860/JCDR/2017/23095.9450] [PMID: 28384913]
[37]
Abdelfattah, A.A.M.; Rizk, F.; Hawash, N.; Hanafy, A.; El-Kalla, F.; Abd-Elsalam, S. Randomized trial of preoperative administration of oral pregabalin for postoperative analgesia in patients scheduled for radiofrequency ablation of focal lesions in the liver. Int. J. Hyperthermia, 2018, 34(8), 1367-1371.
[http://dx.doi.org/10.1080/02656736.2018.1424946] [PMID: 29308685]
[38]
El-Gebaly, F.; Abou-Saif, S.; Elkadeem, M.; Helmy, A.; Abd-Elsalam, S.; Yousef, M.; Elkhouly, R.A.; Amer, I.F.; El-Demerdash, T. Study of serum soluble programmed death ligand 1 as a prognostic factor in hepatocellular carcinoma in Egyptian patients. Curr. Cancer Drug Targets, 2019, 19(11), 896-905.
[http://dx.doi.org/10.2174/1568009619666190718141647] [PMID: 31538897]
[39]
Badawi, R.; Soliman, H.; Ziada, D. Serum markers as a predictor of hepatic fibrosis compared to fibroscan in chronic hepatitis B infected Egyptian patients: A cross-sectional study. Open Biomark. J., 2020, 10, 69-75.
[http://dx.doi.org/10.2174/1875318302010010069]
[40]
Mohamed, A.A.; El-Toukhy, N.; Ghaith, D.M. Talin-1 gene expression as a tumor marker in hepatocellular carcinoma patients: A pilot study. Open Biomark. J., 2020, 10, 15-22.
[http://dx.doi.org/10.2174/1875318302010010015]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy