Prognostic analysis of transarterial chemoembolization combined with a traditional Chinese herbal medicine formula for treatment of unresectable hepatocellular carcinoma

Background Transarterial chemoembolization （TACE） is the most widely used primary treatment for unresectable hepatocellular carcinoma （HCC） due to its survival benefit, though its clinical effect is still far from satisfactory. Jiedufang （JDF） granule preparation is a commonly used Chinese herbal medicine formula for HCC. The aim of this study was to evaluate the effect of combined therapy with TACE and JDF granule preparation in treatment of unresectable HCC on survival. Methods A retrospective study of TACE was performed in 165 patients with unresectable HCC who were admitted between January 2002 and December 2007 in Changhai Hospital, Shanghai, China. Of the 165 patients, 80 patients （study group） received combined therapy consisting of TACE and a long-term maintenance treatment with oral JDF granule preparation, and the remaining 85 patients （control group） received TACE alone. The survival rates of both groups were calculated by the Kaplan-Meier method. Factors possibly affecting survival were assessed by multivariate analysis in the Cox proportional hazard model, such as maximum tumor size, number of lesions, portal vein invasion, and etc. Results The median overall survival was 9.2 months （95% CI： 6.94-11.46） in the study group versus 5.87 months （95% CI： 4.21-7.52） in the control group. In the study group,survival rates of the 1-, 2- and 3-year follow-up were 41.2%, 18.4%, and 9.6%, respectively. Significant independent prognostic factors identified by the Cox regression analysis were as follows： serum hepatitis B surface antigen （HBsAg） （P=0.014）, maximum tumor size （P=0.027）, number of lesions （P 〈0.001）, portal vein invasion （P 〈0.001）, and the therapy model （P=-0.006）. Conclusion Combination therapy of TACE and JDF granule preparation may significantly prolong survival of patients with unresectable HCC.     

Meta-analysis on radiofrequency ablation in combination with transarterial chemoembolization for the treatment of hepatocellular carcinoma

To evaluate the efficacy and safety of transcatheter arterial chemoembolization （TACE） combined with radiofrequency ablation （RFA） and TACE alone for hepatocellular carcinoma （HCC）, Pubmed, Cochrane Library, Web of Science, China National Knowledge Infrastructure （CNKI） and Wanfang Datebases were searched for the randomized controlled trials （RCTs） and retrospective cohort studies from the establishment of the databases to January 2014. The bibliographies of the included studies were searched, too. After study selection, assessment, data collection and analysis were under- taken, we performed this meta-analysis by using the RevMan5.2 software. Seventeen studies involving 1116 patients met the inclusion criteria with 530 treated with RFA-plus-TACE and 586 with TACE alone. The results of meta-analysis showed that the combination of TACE and RFA was obviously as- sociated with higher 1-, 2-, and 3-year overall survival rates （OR1-year=3.98, 95% CI 2.87-5.51, P〈0.00001; OR2-year=3.03, 95% CI 2.10-4.38, P〈0.00001; OR3-year=7.02, 95% CI 4.14-11.92, P〈0.00001） than TACE alone. The tumor complete necrosis rate in patients treated with TACE and RFA was higher than that of TACE alone （OR=13.86, 95% CI 8.04-23.89, P〈0.00001）. And there was a significant difference in local recurrence rate between two different kinds of treatment （OR=0.24, 95%CI 0.14-0.44, P〈0.00001）. Additionally, combination of TACE and RFA was associated with higher complete tumor necrosis rates than TACE mono-therapy in the treatment of HCC. However, RFA plus TACE was found to be associated with a lower local recurrence rate than TACE monotherapy TACE-plus-RFA treatment was associated with a higher response rate （RR） than the TACE-alone treat- ment （OR=3.90, 95% CI=2.37-5.42, P〈0.00001）. TACE-plus-RFA treatment did not differ from the TACE-alone treatment in terms of stable disease （SD） rate （OR=0.38, 95% CI=0.11-1.26, P=-0.11）. Meta-analyses showed that the combination of RFA and TACE was assoc     

Effects of Sorafenib combined with chemoembolization and radiofrequency ablation for large, unresectable hepatocellular carcinomas

Background The prognosis of unresectable large hepatocellular carcinomas is poor. This study evaluated the efficacy and safety of sorafenib combined with transcatheter arterial chemoembolization and radiofrequency ablation in the treatment of hepatocellular carcinomas larger than 5 cm. Methods The treatment of 22 patients with large, unresectable hepatocellular carcinomas （5.0-16.5 cm） treated with sorafenib after transcatheter arterial chemoembolization combined with radiofrequency ablation between 2007 and 2011 was reviewed. The local effects, survival rates, toxicity, and prognostic factors were analyzed. Results During a follow-up of 9-49 months, 19 patients died and three survived. The median overall survival was 32 months. The overall cumulative 12, 24, and 36-month survival rates were 85.9%, 66.8%, and 23.5% respectively. Technical effectiveness was achieved in 12 out of 28 lesions （42.85%） at the first CT check. The median time to tumor progression was 21 months. The progression-free survival rates at 6, 12, and 24 months were 90.9%, 72.0%, and 38.4%, respectively. Combined therapy was generally well tolerated. There was only one major procedure-related complication, biloma （4.5%）. Sorafenib-related adverse events exceeding grade 3 were hand-foot skin reaction （2/22, 9.1%）, gastrointestinal hemorrhage （1/22, 4.5%）, and diarrhea （2/22, 9.1%）. The absence of vascular invasion before treatment was found to be the best prognostic factor in the univariate analysis. Conclusions Sorafenib combined with transcatheter arterial chemoembolization and radiofrequency ablation is a promising approach to the treatment of large, unresectable hepatocellular carcinomas. However, large-scale randomized clinical trials are needed to determine the future role of this treatment.     

Changes in immunological function after treatment with transarterial chemoembolization plus radiofrequency ablation in hepatocellular carcinoma patients

Background Different strategies for hepatocellular carcinoma （HCC） may have distinct effects on the immune system.The aim of this research was to investigate changes in the immunological function after transcatheter arterial chemoembolization （TACE） plus radiofrequency ablation （RFA） in HCC patients.Methods A total of 51 consecutive HCC treatment-naive patients was enrolled in this study and 20 healthy subjects served as controls.The therapeutic strategy was selected according to the tumor stage and general conditions.TACE was performed in 25 cases,TACE plus RFA in 17 and RFA in nine.All the patients underwent routine examinations and peripheral blood was harvested for the detection of lymphocyte subset by flow cytometry 1 day before,and 2 and 4 weeks after the treatment.The serum levels of alpha-fetoprotein （AFP）,ALT and AST were also measured before and 4 weeks after treatment for the evaluation of therapeutic efficacy and liver function impairment.Results When compared with healthy controls,the CD4/CD8 ratio and the number of B cells and natural killer （NK） cells were significantly decreased in HCC patients before treatment （P 〈0.05）.When compared with before treatment,the CD4＋ cells and CD4/CD8 ratio decreased but CD8＋ cells increased in the TACE group （P 〈0.05）; the CD4/CD8 ratio and NK cells decreased but CD8＋ cells increased in the TACE-RFA group （P 〈0.05）; the CD3＋ cells,CD4＋ cells,CD4/CD8 ratio and NK cells increased in the RFA group （P 〈0.05）.Significant differences in the CD3＋ cells,CD8＋ cells,CD4/CD8 ratio and NK cells were observed among groups （P 〈0.05）.Moreover,the AFP level decreased and transaminase level increased in all groups （P 〈0.05）.Differences of pre and post treatment between groups were statistically significant （P =0.016,0.025,0.018 respectively）.Conclusions Immunity was compromised in HCC patients; TACE and TACE plus RFA lowered immunologic function to a certain extent.RFA improved it accompanied by a protective effect on liver function.     

Chinese Medicine Herbal Treatment Based on Syndrome Differentiation Improves the Overall Survival of Patients with Unresectable Hepatocellular Carcinoma

Objective:To investigate the effects of Chinese medicine(CM) herbal treatment based on syndrome differentiation on patients with unresectable hepatocellular carcinoma(HCC).Methods:A total of 94 patients with unresectable HCC were reviewed between June 2008 and June 2011.Survival analysis was performed between patients who received CM with/without non-curative antitumor treatments of Western medicine(WM)(CM group,30cases) and patients who were not treated with CM but with non-curative antitumor treatments of WM or supportive treatment alone(non-CM group,64 cases).Then,survival analysis was performed between patients treated with CM combined with non-curative antitumor treatments of WM(combination therapy group,25 cases) and patients with non-curative antitumor treatments of WM alone(non-curative antitumor treatments group of WM,52 cases).The survival analysis was performed by Kaplan-Meier method and prognostic factors for overall survival(OS) were assessed by the Cox proportional hazards regression model.Results:The median survival time(MST),1- and 2-year survival rates of the CM group and the non-CM group were 36 months,76.7%,56.1%and 12 months,48.4%,26.6%,respectively.The Log-rank test revealed significant difference between the two groups in OS(P<0.01).Cox proportional multivariate analysis revealed that CM was an independent favorable prognostic factor for OS.The MST,1- and 2-year survival rates of combination therapy group and non-curative antitumor treatments group of WM were 36 months,76.0%,55.5%and 13 months,55.8%,30.8%,respectively.There was significant difference in OS between the two groups(P=0.004).Conclusions:CM herbs based on syndrome differentiation have positive effects on survival of patients with unresectable HCC.Furthermore,combination therapy of CM and WM are recommended in HCC treatment.     

Efficacy and feasibility of radiofrequency ablation for decompensated cirrhotic patients with hepatocellular carcinoma

Background Most HCC patients with decompensation of liver function lost the chance of surgical and/or interventional treatment. The aim of this study was to evaluate feasibility and outcome of radiofrequency ablation （RFA） in treating hepatocellular carcinoma （HCC） patients with poor liver function （Child-Pugh class C）, who are not suitable for surgery or hepatic artery chemo-embolization.Methods Thirteen HCC patients （the number of tumors was 17） with liver function of Child-Pugh C （scores： 10.2±0.4）were included in the study. Among the patients, 8 were male and 5 were female with the average age of （61.6±10.9）years old. The average size of HCC was （3.8±1.0） cm. Two patients were recurrent HCC and 30.8% of the patients had multiple tumors （2-3 tumors）. All the patients were treated with RFA.Results There were 22 RFA sessions （1-4 sessions per patient） in all, average ablations per tumor at first session was 3.1. One week after RFA, the liver enzymes elevated in 9 patients （69.2%）, in 7 of them, the liver enzyme returned to pre-RFA level in 1-3 months. One month after RFA, the Child-Pugh grading was 10.3±0.8 （Child-Pugh C）, while that of pre-RFA was 10.2±0.4 （Child-Pugh C）, with no significant difference. Computer tomography （CT） one month after RFA showed that the tumor necrosis rate was 88.2% （15/17）. Five patients had 2-4 repeated RFA due to HCC recurrence.During the follow-up of 2-69 months in this group, survival rate of one year was 53.8%, two years was 30.8%, and three year was 15.4%. The incidence of RFA-related complications was 13.6% （3/22 sessions）, including 1 case of GI hemorrhage and 1 sub-capsular hemorrhage of the liver. One patient with HCC over 5 cm who had fever and liver abscess after RFA, and was dead 2 months later due to liver function failure.Conclusions Minimal invasive RFA provides possible treatment modality for HCC patients with poor liver function, who are not candidates for surgical and/or interventional therapy. For large HCC, due to the required extended treatment region, special attention should be paid to the possibility of acute liver failure.     

460 Cases of Radiotherapy for Primary Massive Liver Cancer

Objective To summarize the improvement of technological by radiotherapy with moving split fields radiation （MSFR） of the whole liver and diminution field technology and split course and to explore the significance by radiotherapy for primary massive Liver Cancer （PLC）. Methods 460 patients with PLC underwent in our hospital between 1987 and 2001 were carried out for retrospective analysis. There were 386 male and 74 female cases of these patients, and the average age was 46.2 years, The tumor size of 245 patients is 10-15 cm. The others is 15-21 cm. There were three groups defined by the irradiation doses： （1） 260 patients treated with moving split fields radiation （MSFR） of the whole liver twice, mTD 16-19 Gy. （2） 127 patients treated with MSFR of the whole liver 3-4 times, mTD 24-35 Gy. （3） 73 patients treated with moving split radiation of the whole liver and diminution field technology and split course, mTD 50-60Gy. Results （1） The tumor size of group 1 had been reduced 10-20%, and the painless rate （Clinical Benefit Response CBR） was 81.5% （2121260）. The half-year and 1-year survival rate was 62.8% and 19.8%, with median survival duration of 8 months. （2） The tumor size of group 2 had been reduced 20-30%, and the painless rate （CBR） was 90.5% （1151127）, the half-year and 1-year survival rates were 82.5% and 28.5%, with a median survival duration of 11 months. （3） The tumor size of group 3 had been obviously reduced more than 40-50%, CBR was 100%. 1-, 2-, 3-, 4- and 5-year survival rate were 95.8%, 69.8%, 47,9%, 27.3% and 10.9%. 10 patients of them, whose median tumor diameter reduced from 14cm to 7cm, accepted operation after radiotherapy, and the 5-year and 10-year survival rate were 40% and 30%, with the longest survival duration of more than 18 years. Conclusion It has been proved that technological radiotherapy about the MSPR of the whole liver, diminution field technology and split course, could he safe and effective selection with the treatment of PLC. There are more fields of indication than usual. It is technologic improvement among the design of radiate field, boost of the posology in target area and the radioactive tolerance dose. It is suggestible for applying and exploring in further places.     

Comparison of Dose-dense ABVD and Standard ABVD in the Treatment of Early Unfavorable and Advanced Hodgkin’s Lymphoma: A Retrospective Analysis

This retrospective analysis compared standard regimen of doxorubicin, bleomycin, vin- blastine, and dacarbazine （ABVD） with the dose-dense ABVD regimen （ABVD-21） in terms of effi- cacy and toxicity. Patients who had early-stage unfavorable or advanced Hodgkin＇s lymphoma （HL） according to German Hodgkin Study Group criteria from March 1999 to February 2011 were ana- lyzed for treatment response, long-term survival and hematological toxicity. There were 85 patients in the ABVD-21 group and 118 patients in the ABVD group respectively. The complete remission rates aider completion of treatment were 92.9% and 90.7% for ABVD-21 and ABVD, respectively. During a median follow-up period of 62 months, no significant difference was found in projected 10-year progression-free survival （PFS） and overall survival （OS） rates （84.7% and 94.1% respectively for ABVD-21; 81.4% and 91.5% for ABVD）. Subgroup analyses showed that ABVD-21 was signifi- cantly better than ABVD for patients with IPS〉3 in terms of PFS and OS rates. Grade 3 to 4 leuko- penia （51.8% vs. 28.8%, P=0.001） and neutropenia （57.6% vs. 39.0%, P=0.009） were more common with ABVD-21. We were led to conclude that dose-dense ABVD did not result in better tumor con- trol and overall survival than did ABVD for early-stage unfavorable HL. However, patients at high risk, for example, with IPS〉3, may benefit from dose-dense ABVD.     

Lipiodolization with or without gelatin sponge in hepatic arterial chemoembolization for hepatocellular carcinoma.

Fifty-two patients with unresectable hapatocelluar carcinoma were divided into 2 groups. Group A (n=24) received lipiodolization with gelatin sponge and group B (n=28) lipiodolization alone. Angiography after hepatic arterial chemoembolization revealed a satisfactory accumulation of lipiodol and obliteration of the micovasculature in the tumors in both groups. However, prolonged obliteration of proximal hepatic arteries was noted in 70%-80% of patients in group A, in contrast to the patency of the arteries in group B. Collateral circulation was found more frequently in group A than in group B, in which recanalization of tumor vessels and phenomenon of iodized oil "wash-out" were seen. There were no significant differences in therapeutic effects in patients with low risk. In those with high risk, the response rates were 28.6% and 64.2%. The half-year survival rates were 28.5% and 62.8%, 1-year survival rates 7.1% and 27.5%, and 2-year survival rates 0% and 13.7% in group A and B respectively. The differen     

Symptomatic pulmonary lipiodol embolism after transarterial chemoembolization for hepatic malignant tumor: clinical presentation and chest imaging findings

Background Pulmonary lipiodol embolism after transarterial chemoembolization （TACE） was rare and life-threatening,occasionally reported in previous literatures.We aimed to review the records of 11 patients with pulmonary oily embolism and analyze their characteristics of radiographic findings and risk factors.Methods Records of 478 consecutive patients who underwent 1 026 percutaneous TACE procedures were retrospectively analyzed.Eleven cases with respiratory symptoms were identified as having symptomatic pulmonary lipiodol embolism after TACE.Data of these patients,including clinical presentation,techniques of TACE,imaging features of tumor and chest imaging findings,were assessed.Results Eleven （2.3%） of 478 consecutive patients who underwent percutaneous TACE procedures had a pulmonary oily embolism after procedures.The mean size of target tumors embolized was （13.6＆#177;2.0） cm.All were hyper-vascular.The mean volume of lipiodol was （21.8＆#177;8.2） ml.Pulmonary oily embolisms were revealed within 12-48 hours after TACE.The most severe respiratory symptoms and imaging abnormalities of the eight patients who survived presented between 2 and 5 days after TACE,becoming normal between 12 and 35 days after TACE.Three patients died.Chest CT revealed retention of radiopaque lipiodol in lungs.Conclusions Pulmonary lipiodol embolism occurs easily in patients who have large hyper-vascular hepatic malignant tumor.The high-density lipiodol deposition in the lung field can be used as diagnostic feature.     

TACE联合经皮热消融治疗大肝癌的疗效及预后分析

目的 探讨经皮热消融[射频消融(RFA)及微波消融(MWA)]联合经动脉化疗栓塞术(TACE)治疗大肝癌的疗效及预后.方法 2003年5月至2009年5月中山大学附属第一医院TACE联合热消融治疗45例5～10 cm大肝癌患者,肝功能为Child-Pugh A、B级,其中25例行TACE+RFA治疗,20例行TACE+...     

冷循环微波刀后肝动脉化疗栓塞术治疗原发性肝细胞癌

目的探讨原发性肝细胞癌冷循环微波刀后肝动脉化疗栓塞术的疗效及必要性。方法对165例原发性肝细胞癌患者冷循环微波刀后进行1次以上的TACE治疗。其中男154例,女11例,年龄在19～73岁,平均46岁。肿瘤长径≤3cm者84例,3.1～5.0cm者37例,〉5.0cm者44例。按肝功能Child-pugh分级,A级151例,B级14例。均经病理诊断为肝细胞癌。采用ECO2100冷循环微波刀（南京亿高微波系统工程有限司产品）治疗行冷循环微波刀,并随后常规行CT以评价冷循环微波刀的疗效,然后行TACE,术后1月行CT检查,以评价肿瘤消融情况,并观察生存率,以评价治疗效果。结果冷循环微波刀后完全缓解84例,基本缓解56例,部分缓解25例。冷循环微波刀＋TACE的近期效果为根治性122例、亚根治性13例和姑息性30例。肿瘤消融程度与近期疗效密切相关r=0.877,P〈0.001。肝癌冷循环微波刀＋TACE治疗后总体1,2,3年生存率为78.2%,65.3%,44.0%。结论 TACE对冷循环微波刀后残余的癌灶或微小转移病灶可起治疗作用;尤其对于大肝癌冷循环微波刀后联合TACE是安全有效及必要的。     

射频消融联合肝动脉化疗栓塞与单纯射频消融治疗小肝癌疗效比较

目的对射频消融(RFA)联合肝动脉化疗栓塞(TACE)治疗与单纯射频消融治疗对小肝癌(≤3cm)的疗效进行比较。方法回顾分析我院2007年1月～2012年2月进行的72例小肝癌射频消融治疗患者的临床资料。72例中39例灶行TACE联合RFA,33例单纯行RFA。比较两组肿瘤完全消融率,复发率,复发时间,术后1、2、3年生存率等情况。结果 TACE联合RFA组肿瘤完全消融率92.31%,局部复发率28.21%,局部复发时间(13.75±3.67)月,1、2、3年的生存率分别为89.74%、76.92%和66.67%。单纯RFA组肿瘤完全消融率90.91%,局部复发率30.30%,局部复发时间(12.23±2.68)月,1、2、3年的生存率90.91%、72.73%、69.70%。结论射频消融联合肝动脉化疗栓塞及单纯射频消融治疗小肝癌(≤3cm)疗效相当,因此联合治疗对小肝癌可能没有必要。     

肝动脉化疗栓塞联合射频消融术治疗肝癌的临床观察

目的 探讨肝动脉化疗栓塞(TACE)联合射频消融术(RFA)对肝癌综合治疗的效果.方法 47例原发性肝癌,分为单纯TACE组25例,联合组22例,先行TACE治疗,再行RFA治疗.治疗效果以1个月后增强CT扫描及甲胎蛋白(AFP)水平评估.结果 治疗后TACE和联合组AFP转阴率分别为39.1%和52.6%(P=0.428);缓解率分别为40%和72.7%(P=0.025);1年生存率分别为64%和86.4%(P=0.007).结论 TACE联合RFA治疗效果优于单纯化疗栓塞.     

射频消融术联合肝动脉化疗栓塞治疗肝癌的临床效果

目的探讨射频消融术后联合肝动脉化疗栓塞对肝癌的治疗效果.方法28例肝癌患者共33个瘤灶,中等大小肿瘤(3～5 cm)9个,大肿瘤(＞5.1 cm)24个.射频消融术后2～8周行肝动脉化疗栓塞术.治疗效果采用增强CT扫描和临床随访评估.结果RFA术后CT扫描见治疗区仍有残留癌灶.TACE后CT扫描见大部分残留癌灶碘油沉积良好.20例患者AFP转阴或明显下降.25例临床随访,累计生存率＞1年(88.0%),＞2年(72.0%).结论射频消融术后联合肝动脉化疗栓塞是一治疗肝癌的有效方法.     

肝动脉化疗栓塞联合射频消融治疗肝转移瘤

目的探讨肝动脉化疗栓塞（TACE）联合射频消融（RFA）治疗肝转移瘤的临床疗效。方法选取不能行手术切除的肝转移瘤35例,经肝TACE联合RFA治疗,观察近期疗效及6、12、18个月的生存率。结果 35例肝转移瘤共154个病灶行49次肝TACE及42次RFA,病灶的完全坏死率为85.7%（30/35）,全部病例6、12、18个月生存率分别为100%、94.3%、88.6%。结论 TACE联合RFA治疗肝转移瘤是一种有效的微创治疗方法。     

RFA和TACE联合应用对原发性肝癌的疗效分析

目的　通过回顾性研究比较射频消融(radiofrequencyablation ,RFA ) ,经导管动脉栓塞化疗(transcatheterarterychemoembolization ,TACE)以及联合RFA和TACE治疗不可切除肝癌病人的疗效。方法　以39例经过组织学证明的原发性肝癌患者为研究对象。所有病人均不适合接受外科手术切除治疗。其中接受RFA治疗者9例(RFA组) ,接受序惯性TACE治疗者2 0例(TACE组) ,接受联合RFA和TACE治疗者10例(RFA +TACE组,联合组)。结果　①联合组肿瘤完全坏死率(92 .3% )明显高于TACE组(2 4 .0 % )和RFA组(6 0 .0 % ) (P <0 .0 5 ) ,RFA组明显高于TACE组(P <0 .0 5 )。②1年生存率联合组和RFA组显著好于TACE组(P <0 .0 5 ) ,RFA组和联合组无显著性差异。2年生存率联合组显著好于TACE组和RFA组(P <0 .0 5 ) ,而后两者无显著性差异(P >0 .0 5 )。3年生存率联合组显著好于TACE组(P <0 .0 5 ) ,而RFA组与其它两组无显著性差异(P >0 .0 5 )。结论　对于不可切除的肝癌联合RFA和TACE是一种可供选择的有效治疗方法,比单纯TACE或RFA具有明显的优越性。     

经皮热消融同步肝动脉化疗栓塞(TACE)治疗肝癌的临床价值

 目的  本研究旨在评估经皮热消融同步肝动脉化疗栓塞(transarterial chemoembolization,TACE)治疗肝癌的安全性、疗效及价值。方法  对单纯TACE疗效不佳的143位原发性肝癌患者的202个病灶(长径0.8~6.8 cm,中位直径3.3 cm)进行159次热消融同步TACE治疗。治疗程序为:先行肝动脉数字减影血管造影(digital subtraction angiography,DSA),接着超声导引下行热消融术(36次射频消融,123次微波固化治疗),最后行再次造影并超选择栓塞治疗(草酸铂+表阿霉素+碘油)。结果     同步治疗耐受性好,仅见轻微肝功能受损和血液毒性。严重并发症仅见2例肝脓肿、1例胸腔积液及1例胆道狭窄伴梗阻性黄疸。术中同步DSA可提高肿瘤影像显示率,精确确认肿瘤大小、数目及实际浸润范围包括卫星灶和微小转移灶;并可减少出血、局部残留、动静脉瘘及瘤道种植等并发症。本组同步治疗一次完全消融率达90.1%。中位治疗时间间隔8.3月(2~25月),1、2、3年生存率各为96.5%、87.4%、74.8%。结论  研究提示热消融同步TACE治疗肝癌安全有效,与单一治疗相比并未发现其他不良反应;该法扩大了肝癌热消融的适应证,提高一次完全消融率。     

CT导向下射频消融联合TACE治疗原发性肝癌

目的 回顾性评价CT导向下射频消融(RFA)联合肝动脉化疗栓塞术(TACE)治疗原发性肝癌的临床疗效及并发症情况.方法 原发性肝癌患者46例,单个肿瘤直径≤5 cm,总数不超过3个,其中19例患者直接行CT导向下经皮经肝穿刺肝内瘤灶射频消融(RFA组),27例在RFA治疗前1～3周先行肝动脉化疗栓塞术(TACE RFA组).结果 TACE RFA组的肿瘤完全毁损率21/27例(77.8%)明显高于单纯RFA组11/19例(57.9%)(P＜0.01).TACE RFA组局部复发率为22.2%(6/27),明显低于RFA组的42.1%(8/19)(P＜0.01).TACE RFA组和RFA组血清AFP转阴率分别为73.9%和43.8%(P＜0.01).术后常见并发症包括发热、疼痛和不同程度肝功能损害,经护肝和对症治疗后多可缓解和恢复.3例患者术后出现肝包膜下出血,经卧床和止血治疗后停止.结论 RFA术前联合TACE治疗可明显提高肿瘤的完全坏死率,获得更为确切的临床疗效,减少术后肿瘤的复发;CT导向下经皮穿刺射频消融治疗原发性肝癌是一种安全有效的治疗手段.     

健脾化痰法联合肝动脉导管化疗栓塞序贯射频消融治疗大肝癌的临床研究

目的评价中药联合肝动脉导管化疗栓塞(TACE)后序贯射频消融(RFA)治疗大肝癌的疗效。方法 72例(95个病灶)大肝癌患者(肿瘤直径5.1~14.5 cm),TACE治疗后1周行RFA治疗,24 h CT评价,如有漏空现象,给予RFA 1~2次补充治疗,最后一次RFA治疗后1个月再次行TACE巩固治疗。术后所有患者均服用中药健脾化痰方。随访观察治疗效果、并发症和患者生存时间。结果 RFA后完全缓解36例,部分缓解22例,病变进展14例。并发症7例(9.72%),包括电极片灼伤皮肤2例,气胸3例,腹腔出血2例。大肝癌TACE序贯RFA治疗后6个月、1、2、3年生存率分别为97.2%(70例)、73.6%(53例)、47.2%(34例)、33.3%(24例)。结论中药联合TACE后序贯RFA是治疗大肝癌的一种有效治疗模式。