الفهرس 
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Abstract
SUMMARY
Primary liver cancer is the fifth most common cancer worldwide and the third most common cause of cancer mortality.
Percutaneous ablation is considering the best treatment option for patients with early-stage hepatocellular carcinoma who are not candidates for surgical resection or liver transplantation. A good local ablative method should be locally effective to the cancer, non-toxic to nontumorous liver, easy and save to administer.
Tumour ablation is achieved with the use of chemical substances (chemical), modification of the temperature of tumour cells (thermal) or transarterial therapy by delivering chemotherapeutic agents to tumors via their blood supply to induce cytotoxity, necrosis or ischemia.
This work aims to compare the results of some different chemical, thermal and transarterial ablative modalities for HCC treatment.
This study was conducted on 60 patients with HCC. Patients were diagnosed to have HCC based on histopathological examination (fine needle biopsy or FNAC) or hepatic focal lesions by two imaging techniques (ultrasonography and spiral contrast-enhanced computed tomography) plus alpha-fetoprotein level higher than 400ng/ml.
The patients were divided into five groups:
• Group 1: included 15 patients treated by alcohol injection.
• Group 2: included 15 patients treated by ethanol-lipiodol injection.
• Group 3: included 10 patients treated by acetic acid injection.
• Group 4: included 10 patients treated by radiofrequency.
• Group5: included 10 patients treated by transarterial chemoembolisation in Mannheim University hospital-Germany.
Ablation was considered complete if no enhancement had occurred in arterial phase of spiral CT and a negative biopsy or cytology for malignant cells with or without necrotic tissue.
In this study complete ablation was occurred in 100 % in focal lesions less than 3 cm treated by alcohol-lipiodol, acetic acid, radiofrequency and chemoembolisation , while in 66.7% in focal lesions treated by alcohol injection without statistically significant difference.
In focal lesions from 3 to 5 cm, complete ablation had occurred in 50% in alcohol-lipiodol and radiofrequency, 44.4% in alcohol, 42.3% in chemoembolisation and 25% of acetic acid with no statistical significant difference
In lesions less than 3 cm, no local recurrence had been occurred in patients treated by alcohol-lipiodol during follow-up period (24 months) while there was local recurrence in 16.7% in alcohol, acetic acid and radiofrequency groups and in 33.3% in chemoembolisation group with no statistical significant difference.
There is no statistical significant difference between different types of ablative modalities for HCC treatment used in this study (alcohol, alcohol-lipiodol, acetic acid, radiofrequency and chemoembolisation) regarding focal lesion complete ablation, local or new recurrence (de novo) in focal lesions either less than 3 cm or from 3 to 5 cm.
By comparing between focal lesions sized 3 cm or less and focal lesions from 3 to 5 cm in all studied patients, treated by any ablative modality used in this study, revealed that there is statistical significant difference regarding complete ablation and local recurrence after treatment while no statistical significant difference regarding new recurrence (de novo) lesions.
One and two year survival rates were 73.3% and 53.3% in alcohol group, 86.7% and 60% in alcohol-lipiodol group, 70% and 60% in both radiofrequency and acetic acid group and 60 and 40% in chemoembolisation group without statistically significant difference among the studied groups.
The mean survival rate in all studied patients with focal lesion less than 3 cm after follow up period (24 months) was 24 months in both acetic acid and radiofrequency groups, followed by alcohol-lipiodol group 20 months then 18 months in alcohol group and finally 6 months in chemoembolisation group with no statistical significant difference between groups.
The mean survival rate in focal lesion from 3 to 5 cm after follow up period (24 months) was 19 months in alcohol group and 14 months in both alcohol-lipiodol and chemoembolisation groups, then 12 months in radiofrequency group and finally 4 months in acetic acid group without statistically significant difference between groups.
The mean survival in all studied groups after follow up period (24 months) was 19.2 months radiofrequency group, followed by alcohol group 18.7 months then 16 months in alcohol lipiodol group and finally 12 months in both acetic acid and chemoembolisation groups with no statistical significant difference between groups.