Purpose: To estimate the local control rate for combined chemoembolization and RFA of hepatic malignancies greater than 2 cm.

Materials and Methods: 53 tumors (37 HCC, 16 metastases) in 44 patients were chemoembolized with CAM/Ethiodol/PVA followed by RFA the next day. In one case, RFA was performed within 2 weeks. In 7 patients with bilobar disease, the other lobe was treated 4-6 weeks later. Mean tumor size was 4.4 1.7 cm (range, 2.2 to 9 cm). 46/53 tumors were treated using LeVeen probes, 5/ 53 with RITA probes, and 2/ 53 with a Radionics unit. 15 tumors received a single burn, 38 received multiple overlapping burns. Clinical, laboratory, and imaging evaluations were performed one month post-treatment and then every 3 months. Follow-up endpoints were liver transplant or death. Seven patients who neither have received a transplant or died have been followed for a median of 10 months (range 1-36).

Results: Technical success was 98%. In one case using a LeVeen probe, roll-off was not achieved. 9/53 (17%) tumors in 9 patients had residual viable tumor detected on follow-up imaging: 3 at 1 month, 5 more at 4 months, and one at 14 months. These nine patients with residual viable tumor included 4/37(11%) HCC s and 5/16 (31%) metastases. Within this group, one patient also developed intrahepatic progression at 1 month and another had extrahepatic progression at 14 months. 21/ 35 (60%) patients without evidence of local failure progressed elsewhere. 14 had intrahepatic progression, 3 extrahepatic, and 4 both. Progression occurred in 67% of patients with metastases and 41% of those with HCC. Among the 18 patients who progressed intrahepatically, 16 progressed within 10 months and two at 21 months. All extrahepatic progressions occurred within 14 months. 13 patients with HCC underwent liver transplantation. Kaplan-Meier estimated 1-year survival from administration of combination therapy was 55% (median, 16 mo) for HCC and 25% (median, 9 mo) for patients with metastases.

Conclusions: Combining chemoembolization with RFA provided sustained local control for 83% (44/53) of the tumors treated. However, combination therapy demonstrates limited efficacy in preventing new sites of intra- and extrahepatic progression.