Iodized Oil Transarterial Chemoembolization and Radiofrequency Ablation for Small Periportal Hepatocellular Carcinoma: Comparison with Nonperiportal Hepatocellular Carcinoma.

PURPOSE: This study aims to evaluate the treatment outcomes of iodized oil transarterial chemoembolization (TACE) and subsequent radiofrequency ablation (RFA) for small (≤3 cm) periportal hepatocellular carcinoma (HCC) compared with nonperiportal HCC.

METHODS: Twenty-three patients [periportal group (PG); mean age, 59.8 years; 22 men, 1 woman] with periportal HCC (in contact with the portal vein >3 mm in diameter) and 279 patients [nonperiportal group (NPG); mean age, 59.1 years; 234 men, 45 women] with nonperiportal HCC were treated between March 2010 and January 2014. All cases were contraindicated for ultrasound-guided RFA or resection. Mean tumor size was 1.2 cm in each group. The baseline characteristics were not different between the groups, except for alpha-fetoprotein level (41.0 ng/dL in NPG vs. 8.8 ng/dL in PG, p = 0.001). Local tumor progression (LTP), disease-free survival (DFS), overall survival (OS), intrasegmental recurrence, and complications were analyzed using the Kaplan-Meier method and Fisher's exact test.

RESULTS: TACE and RFA were successfully performed in all patients. Mean follow-up period of PG and NPG was 33.8 and 42.8 months, respectively. LTP (p = 0.701), DFS (p = 0.718), and OS (p = 0.359) were not different between the two groups. Intrasegmental recurrence occurred in two patients (one in each group), and its incidence was not different (p = 0.212). Complications requiring further treatment occurred in 1/23 (4.3%) in PG and 5/279 (1.8%) in NPG. No procedure-related mortality occurred.

CONCLUSIONS: Iodized oil TACE and subsequent RFA are effective alternative treatments for small periportal HCC (≤3 cm) when percutaneous ultrasound- or CT-guided RFA or resection is not feasible.