Percutaneous coagulation therapy of hepatocellular carcinoma by combining microwave coagulation therapy and ethanol injection

Objective: To determine if larger hepatocellular carcinoma (HCC) coagulation volumes can be obtained by combining percutaneous microwave coagulation therapy (PMCT) and ethanol injection (PEI) or PEI followed by PMCT with occlusion of the feeding artery. Subjects and methods: Eighty patients with 88 HCCs were treated with (I) PMCT; (II) combined therapy of PEI immediately followed by PMCT; (III) combined therapy of PEI immediately followed by PMCT with occlusion of the feeding artery. The coagulated area was measured at the maximum diameter perpendicular to the needle tract on enhanced computed tomography (CT) scan performed immediately after therapy. The local effect of the treatment was evaluated by enhanced CT follow-up. The rate of complete necrosis was compared in the three treatment groups. Results: The coagulation area and the rate of complete necrosis in group I was 28 ± 4.6 mm and 22.5% (7/31), respectively; the coagulation area and complete necrosis in group II were 36 ± 8.3 mm and 58.6% (17/29), respectively; the coagulation area and rate of complete necrosis in group III were 46 ± 8.5 mm and 92.8% (26/28), respectively. The difference in the coagulation area and the rate of necrosis were significantly larger in the group II than group I (p < 0.001, p < 0.05), and in group III than group II (p < 0.001, p < 0.05). Conclusions: Combined therapy of PEI immediately followed by PMCT, especially with occlusion of the feeding artery can significantly coagulate larger volumes of tumor and improve the rate of complete necrosis.