Clinical Review Of Transcatheter Hepatic Arterial Chemoembolization Combined With Microwave Ablation In Treating Primary Hepatic Carcinoma

ObjectiveTo evaluate the clinical effect and toxic reaction side effect of transcatheter hepaticarterial chemoembolization(TACE) combined with percutaneous microwave ablationtherapy(MWA) in patients with primary liver cancer by retrospective analysis.MethodsRetrospective analysis of68patients with primary liver cancer received TACE andTACE combined with MWA in PLA88Hospital from July2008to September2010.Thepatients had96tumor lesions.36patients performed only in TACE were enrolled in controlgroup.32patients were treated with TACE+MWA as the therapy group.The basic data ofthe two groups was comparability.The patients were performed firstly in TACE andreceived EPI（40mg）+MMC（10mg）+5-FU (1000mg) constituted by EPI（10mg）+LP(10~20ml) or grain of gelfoam to chemoembolization feeding artery of liver cancer.Gelatin sponge particles were embolized before lipiodol with arteriovenousfistula.Hydration、 hemostasis and liver protection were treated after operation. CTinspection or hepatic arteriography was performed after every post-treatment3~4weeks.TACE or TACE+MWA was selected to patients again according to the condition offistula and tumor.Then observed and compared the liver function,reduced rates of AFP andside effects,followed up the rates of recurrence and metastasis,survival time of the twogroups.To evaluate the clinical effect of TACE combined with MWA in patients with livercancer.ResultsAll the Patients showed improvement of clinical symptoms and enhane equality of lifeafter treatment.(1) Effective rate：The efficacy was evaluated by hepatic enhanced CT scanning and color Doppler ultrasound after one month of treatment. In therapy group,9patients were completely relief and17patients were partly relief, the total response raterate was81.25%; In control group,3patients were completely relief and13patients werepartly relief,effective rate was44.44%, there was remarkable difference of effective ratebetween the two groups(P<0.05).The therapy group was better than the control group.(2)Quality of Life(QOL):The rates of improvement in quality of Life were62.50%and36.11%in the therapy group and control group, two groups were significant (P <0.05); Therates of stable and decrease in the therapy group were34.37%、3.13%,which were55.56%、8.33%in the control group, there was no significant difference between the twogroups.The KPS score in the therapy group was (66.44±7.21) before treatment,and(82.84±11.08) after treatment (P<0.05);In the control group there was (69.53±10.89)before treatment,and (76.86±9.03) after treatment (P<0.05).The improvement of KPS inthe therapy group was better than the control group, there was significant differencebetween the two groups after treatment (P<0.05).(3) Survival rate and recurrence rate: The6-month cumulative survival rates were87.50%and80.56%in the two groups, there wasno significant difference.The12-month,18-month cumulative survival rates were71.88%、34.38%and44.45%、13.89%in the therapy group and control group,respectively(P <0.05).The6-month recurrence rates were15.63%and22.22%in the two groups, there was nosignificant difference.The12-month,18-month recurrence rates were25.00%、53.13%and52.80%、77.78%in the therapy group and control group,respectively(P <0.05).(4)AFP andhepatic function: The AFP in the therapy group was (425.13ng/ml±45.49ng/ml) beforetreatment,and (128.19ng/ml±30.67ng/ml) after treatment (P<0.05);In the control groupthere was (437.53ng/ml±51.74.ng/ml) before treatment,and (173.78ng/ml±40.47ng/ml)after treatment (P<0.05).The improvement of AFP in the therapy group was better than thecontrol group, there was significant difference between the two groups after treatment(P<0.05).The hepatic function was improve in the two groups after treatment, there wassignificant difference of hepatic function between the two groups after treatment(P<0.05).(5)Side effect:The main side effect were perspiration、pain、gastrointestinalreaction、 transaminase elevation、fever and myelosuppression.There was significantdifference in perspiration and pain after treatment between the two groups (P <0.01or P<0.05)，and the treatment group was higher than the control group. There was nosignificant difference in others.Symptoms were markedly upturned after one or twoweeks.None had severe complication in the two groups,for example,splenic infarction,gallbladder necrosis,hepatic failure,massive hemorrhage,liver abscess,death etc.ConclusionTACE combined with MWA can safety and effectively treat the patients with primaryliver cancer,superior to only TACE,and can extend life span,improve quality of life,reducerecurrence rate without increase side effects.