Background: This study aimed to evaluate the safety and the feasibility of TACE combined to percutaneous RFA as "single-step" locoregional treatment of HCC or liver metastases.

Methods: From July 2006 to December 2006, sixteen patients (pts) (11with HCC and 5 with liver metastases)without extrahepatic disease and no more than 3 nodules, underwent "single-step" TACE plus RFA. A total of 27 nodules were treated, with a median diameter of 2 cm (range 0.8-6 cm). The procedure consisted, under general anesthesia and during the same session, on TACE (with Epirubicin plus Mitomycin C) administered immediately before and after percutaneous RFA.The baseline staging included total body CTscan and liver CE-US. A CTscan of abdomen was obtained 48 hours after the procedure, in order to detect and manage complications.
One month after the procedure, a CTscan plus a CE-US of superior abdomen were obtained to assess the response.

Results: All patients tolerated the treatment well. Main toxicities were represented by mild abdominal pain, nausea and fever; in addition, grade 2-3 anemia was observed in 2 pts, G 2-3 thrombocytopenia occurred in 4 pts, while transient hyperbilirubinemia (G 3-4) was observed in 3 pts.Grade 2-3 hepatic toxicity occurred in 6 pts, but it didn't required any additional treatment outside standard post-TACE supporting care. The early evaluation by CT scan didn't show complications in any patient, and the radiologycal appearance was generally characterized by a close and homogeneous concentration of Lipiodol inside and in a wide area surrounding the tumors.

Conclusions: The combination of TACE plus RFA during the same session is safe and feasible. Side effects are moderate and easily manageable.The volume of necrosis can be increased both by the hischemic effect of the embolization, and by the hypotesized synergism between antiblastic drugs and RFA; in addition, TACE could improve the adequacy of the technique, by treating synchronous lesions not recognizable by other techniques, and by optimizing the ablation of larger lesions. Further investigation is needed to draw definitive conclusions but, despite the short follow up, our preliminary data suggest that this technique could be effective to improve the local control of disease and survival of these patients.