Study of the Efficacy of Combined RadioFrequency Ablation and Percutaneous Acetic Acid Injection in the Management of Hepatocellular Carcinoma

Hepatocellular carcinoma ( HCC ) is one of the most commonly occurring solid tumors globally and is the most frequent cause of cancer death in some parts of the world such as China and sub.Saharan Africa and the prognosis without treatment is poor . There is an apparent increase in the number of HCC patients in Egypt. It has been reported that in a period of 33 months, out of 11492 patients attending with abdominal complaint in Tropical Medicine Research Institute 1352(11.76%) were found to have HCC. Hepatitis C is a major health problem in Egypt leading to progression from chronic active hepatitis to cirrhosis to HCC. 321/6850 cases who attended an outpatient liver center in Cairo had HCC. The male to female ratio in these studies was 4:1 to 5: 1 and the mean age was 50.60 years old. Among the various local percutaneous ablative therapies, radio.frequency ablation (RFA) has attracted the greatest interest because of its effectiveness and safety in the treatment of small HCCs, with a 3.years survival rate of 62% - 68%, a treatment.associated morbidity rate of 0%-12%, and a treatment.related mortality rate of 0%-1%. However, complete tumor necrosis rate with RFA for tumors larger than 5 cm is less favorable, and local recurrence rate can be as high as 20%, even for HCCs smaller than 3.5 cm. Percutaneous acetic acid injection ( PAI ) has been used as a potential alternative to Percutaneous ethanol injection (PEI) for therapy of small (less than 3 cm) HCC . It is reported that it has a strong cytotoxic effect than ethanol. It causes tissue necrosis by the same mechanisms of dehydration and protein denaturation. Its low pH induces swelling of the fibers and promotes dissociation of intermolecular collagen. The aim of this work was to evaluate the efficacy of combined RFA and PAI compared to PAI alone the management of HCC of relatively large size 5.8 cm in diameter. 30 patients with single lesions of HCC measuring 5.8 cm in diameter were divided into 2 groups, each composed of 15 patients. Each group was subdivided into 2 subgroups according to the size, group 1a =7 patients (5.6.5 cm in diameter) & group 1b =8 patients (6.6.8 cm) while group 2a=8 patients (5.5. 6 cm) & group2b=7 patients (6.6.8 cm). Group1 was treated by 2. 3 sessions of intralesional injection of 6 ml of 50% acetic acid using 21 gauge spinal needle, 1 week apart. Group2 was treated by one setting of RFA using RF needle with that expand on deployment up to 5 cm in diameter plus 2.3 sessions PAI as in group1. Complete ablation was achieved in 46.6% of group 2 treated by combination of RFA and 2.3 sessions of PAI, compared to 20% of group1 treated by 2.3 sessions of PAI with highly significant difference. Dividing the groups into 2 subgroups according to HCC diameter, subgroup a of 5.6.5 cm and subgroup b of 6.6.8 cm in diameter, complete ablation was achieved in 62.5% of subgroup 2a compared to 28.5% of subgroup 1a In conclusion combination therapy of PAI plus RFA is needed if better ablation is seeked. (Ahmed Abdelalim, Mohamed Salah Ali and Aid Elgammal. Study of the Efficacy of Combined RadioFrequency Ablation and Percutaneous Acetic Acid Injection in the Management of Hepatocellular Carcinoma. J Am Sci 2013;9(6):622.631). (ISSN: 1545.1003). http://www.jofamericanscience.org . 79