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Ethical consideration afterwards and then every 3 months following the procedure:
Ethical approval was obtained from the Local Ethical full clinical examination, CBC, prothrombin concentration,
Committee of the Department of Tropical Medicine, Ain liver function tests, kidney function, AFP and spiral CT
Shams University. Written informed consent was obtained of abdomen. Classification of response was conducted
from all participants. The right to refuse participation was according to the European Association for the Study of Liver
emphasized. amendments that take into account the reduction in viable
tumor volume due to TACE-induced necrosis as follows.
Patients Complete response (CR): complete disappearance of all
The study included 50 cases of diagnosed HCC on top of known disease and no new lesions; partial response (PR):
chronic liver disease divided into two groups according to at least 50% reduction in total tumor load of all measurable
treatment modality. Group 1: 25 HCC patients underwent lesions; progressive disease (PD): at least 25% increase in
TACE only as a control group with 10 (40%) patients with size of one or more measurable lesions or the appearance
single tumor sizes of 5 cm and 15 (60%) patients with single of new lesions; stable disease (SD): does not qualify for CR/
tumor sizes of 5-7 cm. Group 2: 25 HCC patients underwent PR or PD. [7]
RFA followed by TACE (RFA-TACE) within 5 days with 14 (56%)
patients with single tumor sizes of 5 cm and 11 (44%) patients Radiofrequency ablation was performed percutaneously under
with single tumor sizes of 5-7 cm. ultrasound guidance after general anesthesia. RITA (Mountain
View, California, USA) and Boston Scientific (Natick,
All patients fit clinical, biochemical, radiological (ultrasound) Massachusetts, USA) expandable-type electrodes were
criteria of chronic liver disease and had positive hepatitis C used. These electrodes had multiple thin curved monopolar
virus (HCV) Ab and/or HbsAg. HCC was diagnosed by evidence electrodes extending from the central cannula (18-14 gauge).
of high  fetoprotein (AFP) (> 200 ng/mL) and/or presentation Radiofrequency emanates from each of these hooks, resulting
of HCC characteristics by triphasic spiral abdominal computed in increased coagulation. Also Valley Lab (Boulder, Colorado,
tomography (CT), according to American Association for the USA) cooled-tip electrodes (17 gauge) were used. These
Study of Liver Diseases guidelines. [7] electrodes have two hollow lumens that permit continuous
internal cooling of the tip. Using percutaneous endovascular
Inclusion criteria techniques, TACE was performed by selective catheterization
We included patients with Child-Pugh class A or B of the hepatic segmental arteries nourishing the lesions, using
presentations, prothrombin concentrations of > 50%, platelet either 5-F catheters (Simmons 1 and Cobra; Mallinckrodt, St.
counts of > 50,000 per mm , and ultrasound detection of Louis, USA or Hydrophilic Simmons 1 and Cobra; Terumo,
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the lesion to be allowed for percutaneous loco-regional Tokyo, Japan) or 3-F coaxial microcatheters (Tracker 18;
ablation therapy. Vascular Access System, Target, St. José, USA; SP Catheter;
Terumo). TACE was used to deliver potent anticancer drugs
Exclusion criteria directly into tumor-feeding arteries. As a result, tumors were
Patients with Child-Pugh class C presentations tumors in exposed to very high drug concentrations, while systemic
inaccessible sites or close to vital structures, malignant main exposure was minimized. The cytotoxic lipiodol mixture
portal vein involvement and/or extrahepatic metastases. All was prepared by mixing 100 mg adriablastin powder with
patients were categorized according to the Barcelona-Clinic liver 10 mL of saline, water soluble contrast and 10 mL of oily
cancer (BCLC) Staging System of HCC pre- and post-treatment contrast (Lipiodol Ultra-Fluid; Jubilant HollisterStier General
to evaluate the general condition, performance status of liver Partnership 16751 Trans-Canada Highway, Kirkland, Quebec,
functionality, Child-Pugh scores and Okuda stage. [8-11] Canada) to ensure a homogenous mixture. Embolization was
done by mixing small pieces of gel foam particles and water
Procedures soluble contrast.
All of the enrolled patients were subjected to tests of:
complete blood count (CBC), alanine transaminase, aspartate Statistical analysis
transaminase, serum albumin, serum bilirubin, prothrombin The collected data were statistically analyzed using the
time and international normalized ratio (INR), hepatitis program SPSS (Statistical Package for Social Sciences,
markers (HCV Ab, HBsAg and HBcAb), AFP, chest X-ray, software version 18.0, Echosoft Corporation, USA). Data were
abdominal ultrasonography and abdominal triphasic spiral CT. expressed as mean ± standard deviation for quantitative
parametric measures in addition to median percentiles for
In post-treatment follow-up studies, all patients were quantitative non-parametric measures and both number and
subjected to the following evaluation measures 1-month percentage for categorized data. The following tests were

20 Hepatoma Research | Volume 1 | Issue 1 | April 15, 2015