Iezzi Roberto, Pompili Maurizio, Posa Alessandro, Coppola Giuseppe, Gasbarrini Antonio, Bonomo Lorenzo
Roberto Iezzi, Alessandro Posa, Giuseppe Coppola, Lorenzo Bonomo, Department of Bioimaging, Institute of Radiology, "A. Gemelli" Hospital - Catholic University, 00168 Rome, Italy.
World J Gastroenterol. 2016 Feb 14;22(6):1935-42. doi: 10.3748/wjg.v22.i6.1935.
In recent years, a combination of intervention therapies has been widely applied in the treatment of hepatocellular carcinoma (HCC). One such combined strategy is based on the combination of the percutaneous approach, such as radiofrequency ablation (RFA), and the intra-arterial locoregional approach, such as trans-arterial chemoembolization (TACE). Several types of evidence have supported the feasibility and benefit of combined therapy, despite some studies reporting conflicting results and outcomes. The aim of this review was to explain the technical aspects of different combined treatments and to comprehensively analyze and compare the clinical efficacy and safety of this combined treatment option and monotherapy, either as TACE or RFA alone, in order to provide clinicians with an unbiased opinion and valuable information. Based on a literature review and our experience, combined treatment seems to be a safe and effective option in the treatment of patients with early/intermediate HCC when surgical resection is not feasible; furthermore, this approach provides better results than RFA and TACE alone for the treatment of large HCC, defined as those exceeding 3 cm in size. It can also expand the indication for RFA to previously contraindicated "complex cases", with increased risk of thermal ablation related complications due to tumor location, or to "complex patients" with high bleeding risk.
近年来，多种介入治疗方法联合应用于肝细胞癌（HCC）的治疗。其中一种联合策略是基于经皮途径（如射频消融术（RFA））与动脉内局部区域途径（如经动脉化疗栓塞术（TACE））的联合。尽管一些研究报告了相互矛盾的结果和结局，但多种证据支持联合治疗的可行性和益处。本综述的目的是阐述不同联合治疗的技术方面，并全面分析和比较这种联合治疗方案与单独进行TACE或RFA单一疗法的临床疗效和安全性，以便为临床医生提供客观的意见和有价值的信息。基于文献综述和我们的经验，当手术切除不可行时，联合治疗似乎是治疗早期/中期HCC患者的一种安全有效的选择；此外，对于直径超过3 cm的大肝癌，这种方法比单独的RFA和TACE治疗效果更好。它还可以将RFA的适应证扩展到以前因肿瘤位置导致热消融相关并发症风险增加的“复杂病例”，或有高出血风险的“复杂患者”。
