Intraoperative radiofrequency thermal ablation combined with portal vein infusion chemotherapy and transarterial chemoembolization for unresectable HCC

BACKGROUND/AIMS: We conducted a preliminary study to determine the feasibility of therapy consisting of intraoperative radiofrequency thermal ablation combined with portal vein infusion chemotherapy and transarterial chemoembolization (IRFAPA) for unresectable hepatocellular carcinoma (HCC). METHODOLOGY: Between September 2001 and June 2004, 34 patients with unresectable HCC were enrolled into a prospective study. 18 cases underwent IRFAPA (group I and 16 cases underwent percutaneous RF ablation (PRFA, group II). Patients' outcomes for IRFAPA and PRFA were recorded and compared. RESULTS: Patients undergoing IRFAPA or PRFA were similar in age, liver function, tumor size, serum AFP, distribution of tumor, mortality, complication and complete ablation rates. In five patients in group II seven new lesions were found during operation. The rate of distant intrahepatic recurrence between the two groups had differences (11.1% vs. 50.0%, P=0.023) although the cumulative recurrence-free survival between the two groups had no differences (P=0.7808). There was a significant difference in the overall survival (P=0.0407). The 1-year and 3-year cumulative overall survival rate was 87.5% and 73.3%, 52.2% and 20.4% in group I and group II, respectively. CONCLUSIONS: IRFAPA is an effective and safe procedure for unresectable HCC. IRFAPA is preferred to PRFA therapy if the patients' conditions can tolerate laparotomy.