Therapeutic Effect Of Transcatheter Arterial Chemoembolization (TACE) Prior To High-intensity Focused Ultrasound (HIFU) For Patients With Advanced Hepatocellular Carcinoma80Cases

Aim: to evaluate the efficacy of transcatheter arterialchemoembolization (TACE) plus High-intensity focused ultrasound(HIFU) in the treatment of advanced hepatocellular carcinoma (HCC).Method: Between January2007and August2011,80patients withadvanced hepatocellular carcinoma were selected and divided in twogroups: group A (n=35), in which patients received TACE only; and groupB (n=45), in which HIFU was performed followed by TACE. In group A,with Seldinger method, a vascular catheter was inserted through thefemoral artery, and hepatic angiography was performed. After assessingthe hepatic vascular anatomy, TACE was performed through lobar orsegmental hepatic arteries. In group B, JC type focused ultrasound tumortherapeutic system was used, designed by Chongqing HIFU TechnologyCo, Ltd. Chongqing China. With ultrasound real-time orientation monitordevice, HIFU three-dimensional combination scanning therapeutic deviceprovided a transcutaneous ablation effect results in necrosis of tumor in the target region. Immediate therapeutic effects were assessed at the basisof clinical efficacy, liver enzymes test, AFP, MRI or CT before and afterthe treatments.Results: No severe complications were observed in group A; and ingroup B, one patient got fever and one got skin hurt. In group A, ALT(59.8±45.9) U/L, and AST (76.9±55.5)U/L before TACE treatmentcompared to ALT (86.7±59.2)U/L and AST (73.7±49.8)U/L one-twoweeks after the treatment; In group B, ALT (63.4±56.8)U/L, AST(72.5±46.6)U/L before the TACE-HIFU treatment compare to ALT(54.3±30.8)U/L, AST (58.3±27.6) U/L, P<0.05. In group A, before thetreatment the AFP was (943.1±411ng/ml), only6patients had AFPreviewed (942.8±468.5ng/ml); in group B, the median of AFP before andafter the treatment were621.8ng/ml and16.2ng/ml, respectively, P<0.05.After treatment, MRI or CT findings demonstrated coagulation necrosisand blood supply reduction or disappearance of tumor in the target region.The CR-, PR-, NC-, rate of efficacy differ significantly between group Aand group B (11.4%,65.7%,22.9%, respectively, vs28.9%,62.2%,8.9%,respectively, P<0.05).Conclusion: The patients received TACE prior to HIFU would havebetter efficacy than those who underwent TACE alone. The clinicalefficacy, liver enzymes, AFP got improved to some extent, MRI or CTfindings showed coagulation necrosis and blood supply reduction or disappearance of the tumor in the target region.