Debkumar Sarkar, DO: No financial relationships to disclose
Purpose: To examine the outcomes of patients treated with combination therapy transarterial ethanol and lipiodol embolization and percutaneous microwave ablation of unresectable intermediate to large sized Hepatocellular Carcinoma.
Materials and Methods: This an IRB approved restrospective study. From January 2018- October 2018, 20 patients (16M, 4 F, ages 51-85, Mean age 67) with hepatocellular carcinoma (HCC) with solitary lesions less than 6 cm (3.1 cm – 6.0 cm, median 4.1 cm) without extrahepatic disease were treated with combination therapy with trans-arterial ethanol lipiodol embolization followed by percutaneous image guided microwave ablation. Embolization was performed selectively utilizing an emulsion with 1:2 concentration of ethanol and lipiodol. Image guided microwave ablation was performed 1 week post embolization. Univariable analysis of Overall Survival (OS) and Progression Free Survival (PFS) was performed through Kaplan-Meier survival curves and log-rank tests.
Results: Technical success of TAELE followed by MW ablation was 100%. Median OS was not reached as 16 of 20 patients were still living at greater than 36 months. 1,2,3 year survival is 100%, 90% and 80% respectively. Median PFS was not reached as 12 of 20 patients demonstrated complete response with no progression. PFS at 1,2,3 year was 80%, 70%, and 60% respectively. There was a statistically significant increase in OS for lesions < 5cm (p< 0.0001). Hepatitis B was associated with lower PFS (p< 0.05). Location of lesion and presence of cirrhosis did not significantly impact PFS or OS.
Conclusion: Combination therapy with trans-arterial ethanol and lipiodol embolization is an effective method for treating intermediate to large unresectable HCC. This combination therapy is most effective when lesion size is less than 5cm.