Background : Hepatocellular carcinoma (HCC) is one of the most common types of malignant liver tumor, and the third leading cause of cancer mortality worldwide. Trans-catheter arterial embolization with chemotherapy (TACE) has become one of the most popular and effective palliative methods for intermediate stage HCC treatment and downstaging. Percutaneous ablation can reach same results as surgery in early HCC. Morden Flat-Panel C-arm CT (Dyna CT) can combine TACE and ablation, having a better sensitivity and specificity in detecting HCC lesions.

Methods : Patients with HCC underwent a combined locoregional treatment in the form of TACE and/or percutaneous microwave ablation (MWA) with extensive use of Dyna CT for intrahepatic staging, intraprocedural imaging, percutaneous and endovascular navigation, monitoring and evaluation of treatment response.

Results : From January 2022 to January 2023, treatment was started in 24 patients. A complete response according to mRECIST criteria was achieved in 9 (37.5%) – in one case, after combined (TACE + MWA) treatment of HCC BCLC 0 stage, in three cases after combined treatment of stage BCLC A, in three cases after combined treatment of stages BCLC B I and BCLC B II, and in two cases only after TACE of stage BCLC B II. The remaining 15 (62.5%) patients showed a partial or complete response in noduls treated by TACE, and they continue to receive sessions of locoregional therapy.

Conclusions : Dyna CT can combine different locoregional treatment modalities and improve the results of treatment in patients with early and intermediate stages of HCC.