الفهرس 
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Abstract
Background: Hepatocellular carcinoma (HCC) incidence is increasing worldwide. It is the sixth most common neoplasm in the world. Overall, HCC is associated with liver cirrhosis in 80% of cases and it is the leading cause of death among cirrhotic patients. The treatment of patients with HCC has evolved in the last few years. However, curative treatments such as liver resection, liver transplantation or percutaneous ablation, PEI and RF, are applicable in only 30%-40% of cases. Since TACE was introduced as a palliative treatment in patients with unresectable HCC, it has become one of the most common forms of interventional therapy. However, although selective TACE is currently widely used, to our knowledge there are no reported extensive data from large series on both short and long term effects of this treatment on liver function. Because the optimal number of sessions is not known, it is debatable if repeated courses of selective TACE may progressively impair liver function and if they are well tolerated or are limited by major side effects. Aim of work: Evaluate the impact of TACE and RFA on liver function in a consecutive series of patients with HCC and analyze the overall survival and HCC progression free survival probability. Side effects in relation to treatments will also be assessed. Patients and methods: The study was conducted on patients who had surgically inoperable, previously untreated HCC. All patients were completely evaluated for the possibility of providing the proper line of treatment. This evaluation included history taking, clinical examination, laboratory investigation, imaging and endoscopic investigations. After completeness of this work up, 84 patients suitable for loco- regional therapy were enrolled in the study after obtaining a written informed consent. They are treated either by RFA (20 patients) or TACE ( 64 patients). Results: The mean age for diagnosis of HCC was 56.59 ± 6.8 years in group I and 58.15 ± 6.99 years in group II. As the background of causal factor for HCC in the current study, chronic hepatitis C virus infection was much more prevalent than chronic hepatitis B. This finding denotes that chronic hepatitis C virus infection is the most important risk factor for HCC in our locality. As regards the degree of liver damage, 73.4% of cases were Child- Pugh (CP) class A and 26.6% were CP class B in group I. As regards group II, CP class A patients were 65% and CP class B patients were 35%. The normal AFP value of < 20 ng/ml was 32.8% in group I and 30% in group II. The serum AFP level < 400 ng/ml was found in 64.1% of cases in G I and 85% of cases in G II. Abnormal elevation of AFP > 400 ng/ml was found in 35.9% of cases in group I and in 15% of cases in group II. These findings suggest that most HCC lesions were found as a symptomatic by periodical screening systems with ultrasonography and AFP of high-risk populations. As regards the tumor size, the mean tumor size in group I in the present study was 5.7 ± 2.4 cmm.In group II, the mean tumor size was 3.5 ± 1.8 cm.The larger tumor size in the present study may be explained by the delay in application of screening programes. Regarding the number of lesions, it was single in 70.3% of cases and multiple in 29.7% of cases in group I and 75% and 25% respectively in group II. As regards the radiological response to TACE, complete response was reported in 33 cases (55.9%), partial response was reported in 12 cases (20.3%) and lack of response was reported in 14 cases (23.7%). Conclusions: The most important risk factor in our locality is chronic HCV infection. Screening programs should be followed in high risk populations, specially cirrhotic patients, for early diagnosis when there is possibility of applying curative therapies. RFA is effective method for the treatment of small HCC. The tumor size, baseline AFP, CP class and response to treatment were prognostic factors in patients with HCC.