Shrinkage of hepatocellular carcinoma after radiofrequency ablation following transcatheter arterial chemoembolization: Analysis of contributing factors

Objective This study was conducted to investigate tumor shrinkage and influencing factors in patients with hepatocellular carcinoma (HCC) from radiofrequency (RF) ablation following transcatheter arterial chemoembolization (TACE). Methods A total of 222 patients underwent combined sequential treatment of TACE and RF ablation for HCC at our institution between 2008 and 2014. Of those, 86 patients (men, 68; women, 18) who achieved compact iodized oil tagging and complete ablation were included for this retrospective study. We measured three-dimensional tumor diameters and calculated tumor volumes on pre-treatment CT/MRI and follow-up CT scans performed post-TACE, post-ablation, and 1 month post-treatment, respectively. To compare periodically generated tumor diameters and volumes, repeated measures analysis of variance (ANOVA) was applied. Multiple linear regression analysis was performed to identify factors impacting tumor shrinkage after RF ablation. Results Diameters and volumes of HCCs declined significantly in the immediate aftermath of RF ablation (i.e., between post-TACE and post-ablation CT scans) (p < 0.001, for both). Mean reduction rates in tumor diameter and volume immediately after RF ablation were 18.2 +/- 9.1% and 44.4 +/- 14.6%, respectively. Of note, tumors of left hepatic lobe and in subphrenic or perivascular locations showed lower rates of post-ablative volume reduction than those in counterpart locations (p = 0.002, 0.046, 0.024, respectively). Tumor size and liver function did not influence tumor shrinkage after RF ablation. Conclusion In patients with HCC, significant tumor shrinkage occurs immediately after RF ablation. The degree of shrinkage in response to ablative treatment seems to vary by tumor location.