الفهرس 
Introduction & Aim of workOnly 14 pages are availabe for public view
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Abstract
Hepatocellular carcinoma (HCC) is a challenging malignancy in terms of management and its complex etiology. The incidence of hepatocellular carcinoma (HCC) has risen steadily in the last few decades due to the spread of hepatitis B and C virus infections.
Although surveillance by ultrasonography and alpha-fetoprotein level can be used for early detection of small hepatocellular carcinoma, most hepatocellular carcinomas are diagnosed at intermediate or advanced stages and subsequently only 30% of patients get benefit from curative therapies such as resection and liver transplantation.
The aim of the study is to access the efficacy of combination therapy between TACE and RF ablation to treat HCC either in actual or sequential manner.
The study included 70 patients with mean patient’s age (53.30±1.70), (65.7%) were males and (34.2%) were females. All patients had HCC on top of cirrhotic liver with viral hepatitis documented in near all patients and HCV was predominant (64.2%). Based on each patient end point at time of follow up (previous treatment), tumor size, number, location, morphology and overall patient clinical performance, we divided the combination between TACE and RFA into two therapeutic categories. The 1st therapeutic category is ”actual combination therapy” which is a pre-planned therapy for fresh non treated lesions. The 2nd therapeutic category is ”sequential combination therapy’ which deals with previously treated lesions, had current recurrence with the patient clinical performance, lab status and mode of recurrence were the modulators which forced us to select best compatible sequential modality to clean up the recurrent lesion.
Our results showed significant correlation between patient’s clinical stage and treatment outcome at the end of one year follow up. Patients with Child Pugh class A achieved complete response in 54.5% versus 30.7% for class B. patients with Okuda stage I obtained complete response in 55.3% versus 26.08% for Okuda stage II. This reflects the importance of proper patient selection candidate for each interventional procedure to optimize treatment outcome and maintain patient best quality of life.
Performing TACE prior to RFA is beneficial in that; occlusion of hepatic arterial flow by means of embolization contribute to the decrease in the heat sink effects during RFA and increase the ablation volume by RFA, may enhance effect of anticancer agents on cancer cells by the hyperthermia, controls micro-lesions which contribute to recurrence after treatment and disrupt intra-tumoral septae with subsequent facilitates heat distribution within the tumor.