Outcome of transarterial chemoembolization-based multi-modal treatment in patients with unresectable hepatocellular carcinoma

Figure 1 Treatment protocol. TACE: Transarterial chemoembolization; RFA: Radiofrequency ablation; PEI: Percutaneous ethanol injection.

Figure 2 Overall survival according to the Kaplan-Meier method. Significantly better overall survival rates were observed in the treatment group compared with the conservative group (P < 0.001) (A), in the surgical treatment group compared with the loco-regional treatment group (P < 0.001) (B), and in the multi-modal treatment group compared with the single modality group (P = 0.002) (C).

Figure 3 Representative example of multi-modal treatment. A: A 46-year-old male patient had a large hepatocellular carcinoma measuring 11 cm in diameter in the right hepatic lobe; B: TACE was performed; C: After 6 sessions of TACE, 7 sessions of PEI, 6 cycles of systemic chemotherapy, and external radiation therapy, the tumor mass was remarkably reduced; D: After right hepatectomy, 2 cycles of adjuvant chemotherapy were administered. However, two metastatic nodules occurred, one in each lung without hepatic recurrence at 5 mo after right hepatectomy (arrow); E: Wedge resection for metastatic lung nodules was performed, and no hepatic and pulmonary recurrences were observed until 12 years after hepatectomy and metastasectomy (arrow). TACE: Transarterial chemoembolization; PEI: Percutaneous ethanol injection.