الفهرس 
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Abstract
HCC varies widely in incidence throughout the world, with rising incidence in Egypt.
Local ablation is considered the first treatment option for patients with early-stage disease, not suitable for surgical therapy.
MWA has emerged as a new therapeutic option, offering many of the benefits of RFA with other theoretical advantages. The promised benefits of MWA are consistently wider ablation areas, faster ablation times, ability to perform multiple ablations simultaneously, and no requirement for grounding pad.
This study aimed to present our initial experience in the use of different techniques of microwave ablation in the treatment of large hepatocellular carcinoma (HCC) tumors with lesion’s size > 5 cm to < 8 cm. regarding its safety and rate of complete ablation.
The present study was conducted on 40 patients with large sized hepatic focal lesion >5 cm proved to be hepatocellular carcinoma according to American association of the study of liver disease guidelines and referred to HCC Clinic of Kasr AL Ainy University hospital, Cairo University in a period of September 2014 to December 2016 The patient were randomly classified on two groups
group I(20 patients underwent microwave ablation of HCC by the simple technique)
group II(20 patients underwent microwave ablation of HCC by the overlapping technique)
The study focus on the safety, local tumor control, local and distal tumor progression, and estimated survival.. Most of them were accidentally discovered during routine screening for their cirrhotic liver.
All patients were subjected to full clinical assessment and biochemical tests (liver function tests, serum albumin, prothrombin time & concentration, CBC and alpha-fetoprotein).
The ultrasound findings of the studied patients before the procedure showed average sized cirrhotic liver with splenomegaly in most of the studied patients. Most of the studied focal lesions were in the right lobe and were solitary.
Assessment of the disease severity by Child-pugh classification revealed that group I showed child A in 65% and Child B in 35%, while group II showed Child A in 60% and Child B in 40%.
P-MWA was preformed to all patients under ultrasound guidance and under conscious sedation during the process of ablation.
Assessment of response to ablation was done after four weeks from ablation by triphasic CT of the abdomen and AFP; the presence of remaining tumor viability was evaluated during the early phase of the contrast-enhanced CT imaging. All patients in both groups showed increase in the echogenicity of the lesions but there wasn’t any increase in the number of HFL, Intra-lesion arterial signals, appearance of DENOVO lesions or recurrence Of the primary lesions,.
There was significant decline in the median AFP level before and one month after ablation with p-value <0.001
The follow up data of the studied patients showed: In MW (simple) group (I), success rate(no residual intralesional arterial doppler signals could be detected in pretreatment positive cases, No enhancement in both arterial and porto-venous by tri-phasic CT) was reported in 15 (75%) out of 20 patients underwent the ablation, while in group (II), 16 (80%) out of 20 patients underwent the ablation. There was insignificant difference between the two groups.