Lecture: RFA and TACE for HCC

This lecture focused on the locoregional treatments for small HCC.  For nearly a decade, the BCLC staging system has been used to prognosticate and treat HCC.  For unresectable lesions, locoregional therapy is most often considered.

The smallest lesions, < 3 cm, are ideal for radiofrequency ablation (RFA).  Caution is used when the location is next to the colon, gallbladder or a large caliber vessel, because a 5-10 mm sphere of ablation surrounding the tumor is included in the procedure.  Adverse effects are rare, and was quoted at < 5% of cases.  Five year survival is quoted at 50-60%, but may be even higher. 

Another locoregional method is transarterial chemoembolization (TACE).  This option is used when HCC is > 3 cm.  A pelvic (femoral artery) approach allows a catheter to reach the hepatic artery, where contrast is injected and the hypervascular HCC is localized.  Local chemotherapy is injected, and the feeding artery is subsequently embolized.  The most common side effect of TACE is known as the TACE syndrome, whereby the patient may experience abdominal pain and fever for several days, followed by malaise for a couple of weeks.  True adverse events are also rare, and quoted to be around 10%.

Data was showed, which demonstrated that TACE can increase survival even when HCC is very large (>5cm) or when tumor thrombus is present, if the patient is still a Child A cirrhotic.  Otherwise, there is insufficient data supporting its use. 

A newer technique is using drug-eluting beads (DEB) during the procedure.  It is not yet in wide use, but has good outcome data thus far.

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