Radiofrequency Ablation under Computed Tomography Guidance with Simultaneous Transarterial Chemoembolization in Patients with Early-stage Hepatocellular Carcinomas

<b>Purpose:</b> Transarterial chemoembolization for hepatocellular carcinoma can be combined with radiofrequency ablation to improve local control. Radiofrequency ablation is usually performed under ultrasound guidance. Computed tomography can detect lesions in the whole liver, but when performing liver puncture under conventional computed tomography guidance, peripheral intrahepatic vessels cannot be visualized, risking vascular injury. The efficacy and safety of radiofrequency ablation under computed tomography guidance combined with transarterial chemoembolization were evaluated. <b>Material and Methods:</b> A total of 186 procedures performed in 142 patients with hepatocellular carcinoma between September 2016 and December 2021, in which radiofrequency ablation was performed under computed tomography guidance combined with transarterial chemoembolization were evaluated. Patient background, survival, local recurrence, adverse events, and post-procedural bleeding were evaluated. <b>Results:</b> Overall, 28 women and 114 men (median age, 74 years; age range, 49-90 years) were evaluated. The etiology of hepatocellular carcinoma was hepatitis B, hepatitis C, hepatitis B+C, and hepatitis non-B non-C in 49, 27, 28, and 38 patients, respectively. The Child-Pugh score was 5/6/≥7 in 137/41/8, and modified albumin-bilirubin was 1/2a/2b/3 in 97/45/42/2, respectively. The 1-, 2-, and 3-year overall survival rates were 96.1%, 87.4%, and 74.0%, respectively. Local recurrence developed after 33/186 procedures, and the 1-, 2-, and 3-year local recurrence-free survival rates (per procedure) were 86.4%, 76.6%, and 57.5%, respectively. Post-procedural bleeding occurred in 17/186 procedures; 13 required embolization, and 4 stopped bleeding spontaneously. <b>Conclusions:</b> Computed tomography-guided radiofrequency ablation with simultaneous transarterial chemoembolization is a useful treatment for early-stage hepatocellular carcinomas that cannot be detected on ultrasound.