High efficacy of high intensity focused ultrasound without transarterial embolization for hepatocellular carcinoma

Abstract

BACKGROUND: High-intensity focused ultrasound (HIFU) is a new non-invasive treatment modality for unresectable hepatocellular carcinoma (HCC). Transarterial embolization (TAE) before HIFU has been used to increase the efficacy of ablation, but there are disadvantages associated with this approach. OBJECTIVES: This study aims to evaluate the outcome of patients with HCC after HIFU with and without pre-treatment TAE. METHODS: From October 2006 to April 2008, HIFU was performed in 41 patients with unresectable HCC. Twenty-one patients received TAE two weeks before HIFU in the initial phase of study (period 1), whereas 20 patients underwent HIFU alone in the latter phase of study (period 2). Treatment efficacy was compared between two groups. RESULTS: There were no significant differences between two groups in patient demographic and clinicopathologic parameters. The median size of largest tumor was similar in period 1 and period 2 (2.7cm versus 2.1cm). Both groups received similar amount of energy from HIFU. The overall mortality rate was 2.4% and the overall complication rate was 12.1%. The complete tumor ablation rate in period 2 was significantly higher than that in period 1 (95% vs. 65%, P = 0.044). Taking into consideration of the total number of ablated tumor nodules, the complete ablation rate in period 2 was 96%, which was significantly higher than that in period 1 (68%). (P = 0.020) The overall recurrence rate was 44.4%. There was no significant difference in recurrence rate between patients in period 1 (56.2%) and period 2 (35%) (P = 0.501). Short-term survival outcome between the two groups (period 1 vs. period 2) were similar (86.5% vs. 79% at 1 year, P = 0.074). CONCLUSION: HIFU without pre-treatment TAE is more effective than combined treatment approach in terms of high complete tumor ablation rate. HIFU treatment is a promising treatment modality for patients with unresectable HCC.