Neoadjuvant Transarterial Chemoembolization (TACE) before Percutaneous MR-guided Laser-induced Thermotherapy (LITT): Results in Large-sized Primary and Secondary Liver Tumors

Summary Objectives: To evaluate the clinical value of neoadjuvant transarterial chemoembolization (TACE) before MR-guided laser-induced thermotherapy (LITT) for different large-sized liver tumors. Materials and methods : Repeated TACE were performed in 289 patients (mean 4.1 per patient) with unresectable HCC (n = 48) or liver metastases (n = 241) in a neoadjuvant intention using 10 mg/m 2 mitomycin as chemotherapeutic agent and 10 ml/m 2 lipiodol and microspheres for vessel occlusion. Tumor volume was measured by MR-imaging. As soons as the diameter of the tumor was observed to have decreased to less than 50 mm, the patients were treated with MRI-guided LITT 4 to 6 weeks after embolization. Survival rates of the different liver tumors of the combined protocol were compared to the results of the patients who were treated only with TACE or with the results of the patients who were treated directly with LITT. Results: In the neoadjuvant group repeated TACE enabled a reduction in tumor size and tumor perfusion in 166 patients (80 cases of metastases of colorectal cancer, 39 cases of metastases of breast cancer, 12 cases of metastases of other primary tumors, 3 cases of carcinoids and 32 cases of HCC), forming the basis of the performance of 322 (mean 2.0) MR-guided LITT procedures. The median survival period for patients with HCC was after the first treatment 25.0 months for the TACE group, 33.3 months for the LITT group and was statistically significant higher with 36.0 months in the patients with the combined treatment. In contrast to this the median survival for patients with colorectal liver metastases was 15.2 months for the TACE group, 23.6 months for the neoadjuvant treated patients and 32.6 months for the patients treated only with LITT. Conclusion: The combined treatment protocol (TACE followed by MR-guided LITT) appears to be a safe and effective treatment of large unresectable liver tumors. The combination of TACE and LITT results in significant superior survival rates in comparison to the results of TACE alone. HCC showed a better response to the treatment than liver metastases.