الفهرس 
Hepatocellular Carcinoma
Clinical features and disease associationsOnly 14 pages are availabe for public view
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Abstract
Hepatocellular carcinoma (HCC) is one of the most
frequent human malignant neoplasms and the cause of more
than a quarter of a million deaths each year throughout the
world. In Egypt, the annual proportion of HCC showed a
significant rising trend from 4.0% in 1993 to 7.2% in 2002.
Combined RFA and TACE, is a promising new modality
for management of medium and large sized HCC, to obtain a
large coagulation area and to achieve complete ablation.
In this study we evaluated the efficacy of combined
RFA followed by TACE in a single HCC of (5-7cm) in
comparison to TACE alone, also to evaluate local progression
rate, recurrence free survival rate and overall survival rate.
In this study, all Egyptian patients presented to Tropical
Medicine Department and Outpatient Hepatoma Clinic for early
detection and management of hepatic tumors (HCC), Ain Shams
University Hospitals, they were classified into; group I
included 25 patients diagnosed as HCC on top of chronic liver
disease underwent chemoembolization, their ages ranged
between 42 and 70 years (mean 59.6 ± 8.1years) included 22
male patients (88%) and 3 female patients (12%), group II included 25 patients diagnosed as HCC on top of chronic liver
disease underwent Radiofrequency ablation followed by
Chemoembolization within 5 days. , their age ranged between 45
and 68 years (56.6 ± 6.9years) included 22 male patients (88%)
and 3 female patients (12%).
Patients in both groups were subjected to full history
taking, thorough clinical examination and laboratory
investigations including (complete blood picture, liver function
tests, kidney function, hepatitis viral markers and alfa
fetoprotein) together with abdominal ultrasonography (US) and
triphasic spiral computed tomography (CT).
Regarding the clinical manifestation, HCC was discovered
accidentally in (26%) of patients, although (52%) of patient were
complaining of easy fatigueability and (48%) of patients were
complaining of dullacheing pain.
As regards the past history and etiological factors of HCC;
parenteral therapy for schistosomiasis was recorded in (80%) of
patients, history of previous surgical operation was recorded in
(66%) of patients and smoking was recorded in (54%) of
patients. Also our study recorded that (98%) of patients were
seropositive for HCV-Ab and (16%) of patients were
seropositive for (HBsAg, HbcAb).After combined therapy (RFA-TACE), complete response
(CR) was achieved in (100%) of patients with medium and large
sized HCC and none of patients achieved partial response (PR)
or progressive disease (PD), also the rate of objective response
after 7 months was (84%).
At the end of the follow up, there was slight fluctuation in
Child-Pugh score, but there was improvement in the performance
status in patients after combined therapy as patients with PST (0)
were shifted from (56%) to (91%) and those with PST (1) were
shifted from (44%) to (9.1%). Also patients with good follow up
were (60%), while patients with tumor progression and treated
with supportive medical treatment were (4%) after combined
therapy.
Total recurrence rate (local + distant recurrence) at one
year was (36%) and local recurrence (local tumor
progression) rate at 1 year was (16%) after RFA combined
with TACE. So this combined therapy achieved better one
year survival rate (88%) and one year recurrence-free survival
rate (56%) than monotherapy (TACE alone).