Outcomes of Combined, Concurrent, and Sequential Interventional Therapy for Huge Hepatocellular Carcinoma

Background: At present the treatment of huge hepatocellular carcinoma is a complicated and knotty problem in the whole world. This study is to evaluate the clinical efficacy of combined, concurrent, and sequential interventional therapy for huge hepatocellular carcinoma (greater than 10cm in diameter). Methods: Forty seven patients with huge hepatocellular carcinoma (above 10cm in diameter) were treated with comprehensive interventional therapy, including transcatheter arterial chemoembolization(TACE) and followed subsequently radioactive seed iodine 125 brachytherapy or/and percutaneous ethanol injection. Inhibition of hepatitis B virus (HBV) expression and replication together with support therapy of traditional Chinese medicine were performed during therapy. Clinical effects after multidisciplinary treatment were synthetically estimated by AFP level, HBV-DNA content, Child-Pugh grade, Karnofsky performance score, ultrasound sonography, CT and DSA imaging, et cetera. Results: Three patients had serious liver function damage and two have recovered uneventfully after supportive treatment and good protective care while one died of liver failure. The one year, two year, three year survival rates were 76.8%, 55.2% and 29.4%, respectively. Complete response and partial response were achieved in six and ten cases respectively. Multivariate analysis of these variables mentioned above identified the HBV-DNA content and Child-Pugh grade as the independent significant prognostic factors. Conclusion: On the basis of hepatic arterial chemoembolization, iodine 125 brachytherapy or/and ethanol injection would deal a crushing blow to residual liver tumor cells, while the former is better in therapeutic effect than the latter but cost a fortune. Both antiviral treatment and traditional Chinese medicine are effective auxiliary methods of increasing the survival rate, but these charge extra and also need good compliance.