Combined Transarterial Chemoembolization and Microwave Ablation Therapy for Hepatocellular Carcinoma: A Randomized Control Study

Objectives: Few clinical researches have dealt with the treatment of patients with hepatocellular carcinoma (HCC) larger than 3 cm and smaller than 5 cm in the literature. We aimed to compare the feasibility and benefits of combined therapy (transarterial chemoembolization [TACE] and microwave ablation [MWA]) compared with TACE or MWA alone in the treatment of HCC larger than 3 cm and smaller than 5 cm. Methods: This was a prospective study consisting of 300 patients with solitary HCC larger than 3 cm and smaller than 5 cm. Our patients were randomized into three groups; group A included 100 patients who were treated with TACE followed by MWA after 2 weeks, group B included 100 patients who were treated with MWA alone, and group C included 100 patients who were treated with TACE alone. Patients were followed using triphasic computed tomography and blood tests including liver function tests, complete blood count, and α-fetoprotein 1 month after therapy and then every 3 months up to 3 years. Evaluation was assessed using the mRECIST criteria. Results: All procedures were successfully completed without any moderate or severe adverse events. Only minor adverse events were reported and treated with no impact on the patients. Group A showed significant objective response rate (complete response + partial response) in comparison with the other groups (P < 0.001). At 3 years, the overall survival (OS) was significantly higher in the group A than in group B and group C (62% versus 46% and 44%, respectively, P < 0.034). Conclusion: Combined therapy (TACE + MWA) in HCC larger than 3 cm and smaller than 5 cm is better than TACE or MWA alone concerning the tumor response and OS.