The One-Stop Protocol: Immediate Tumor Visualization via TACE and Real-Time Ablation Guidance by CBCT in Synchronous MWA for Recurrent Small HCC

Objective To investigate the clinical efficacy and safety of transcatheter hepatic artery chemoembolization (TACE) combined with cone-beam computed tomography (CBCT)-guided microwave ablation (MWA) in the simultaneous treatment of recurrent small hepatocellular carcinoma (RsHCC). Materials and methods The clinical data of 60 patients who underwent TACE combined with CBCT-guided MWA synchronous treatment for RsHCC from March 2018 to December 2022 in our hospital were retrospectively analyzed. Follow-up was performed at 1, 3, 6, and 12 months after treatment. mRECIST criteria were used to assess the tumor response and analyze the objective remission rate (ORR), disease control rate (DCR), progression-free survival (PFS). Results The initial complete remission (CR) rate of TACE combined with CBCT-guided MWA synchronized treatment for RsHCC was 83.3% (50/60), with an initial ORR and DCR of 100%. The mean progression-free survival time was 37.90 (95%CI:27.10, 48.71) months, tumor progression occurred in 40% (24/60) of patients. Univariate and multivariate analyses showed that the maximum diameter of the tumor (≥ 2 cm and < 3 cm) was a major risk factor for PFS ( HR = 13.74, P = 0.001 ). No serious adverse events occurred in the study. Conclusions TACE combined with CBCT-guided MWA synchronization for the treatment of RsHCC is a highly effective and safe local treatment, especially suitable for lesions with limited conventional image guidance.