Camrelizumab,apatinib and hepatic artery infusion chemotherapy combined with microwave ablation for advanced hepatocellular carcinoma

BACKGROUND Hepatic arterial infusion chemotherapy and camrelizumab plus apatinib(TRIPLET protocol)is promising for advanced hepatocellular carcinoma(Ad-HCC).However,the usefulness of microwave ablation(MWA)after TRIPLET is still controversial.AIM To compare the efficacy and safety of TRIPLET alone(T-A)vs TRIPLET-MWA(TM)for Ad-HCC.METHODS From January 2018 to March 2022,217 Ad-HCC patients were retrospectively enrolled.Among them,122 were included in the T-A group,and 95 were included in the T-M group.A propensity score matching(PSM)was applied to balance bias.Overall survival(OS)was compared using the Kaplan-Meier curve with the log-rank test.The overall objective response rate(ORR)and major complications were also assessed.RESULTS After PSM,82 patients were included both the T-A group and the T-M group.The ORR(85.4%)in the T-M group was significantly higher than that(65.9%)in the T-A group(P<0.001).The cumulative 1-,2-,and 3-year OS rates were 98.7%,93.4%,and 82.0%in the T-M group and 85.1%,63.1%,and 55.0%in the T-A group(hazard ratio=0.22;95%confidence interval:0.10-0.49;P<0.001).The incidence of major complications was 4.9%(6/122)in the T-A group and 5.3%(5/95)in the T-M group,which were not significantly different(P=1.000).CONCLUSION T-M can provide better survival outcomes and comparable safety for Ad-HCC than T-A.

Short-term efficacy of microwave ablation in the treatment of liver cancer and its effect on immune function

BACKGROUND Hepatectomy is the first choice for treating liver cancer.However,inflammatory factors,released in response to pain stimulation,may suppress perioperative immune function and affect the prognosis of patients undergoing hepatectomies.AIM To determine the short-term efficacy of microwave ablation in the treatment of liver cancer and its effect on immune function.METHODS Clinical data from patients with liver cancer admitted to Suzhou Ninth People’s Hospital from January 2020 to December 2023 were retrospectively analyzed.Thirty-five patients underwent laparoscopic hepatectomy for liver cancer(liver cancer resection group)and 35 patients underwent medical image-guided microwave ablation(liver cancer ablation group).The short-term efficacy,complications,liver function,and immune function indices before and after treatment were compared between the two groups.RESULTS One month after treatment,19 patients experienced complete remission(CR),8 patients experienced partial remission(PR),6 patients experienced stable disease(SD),and 2 patients experienced disease progression(PD)in the liver cancer resection group.In the liver cancer ablation group,21 patients experienced CR,9 patients experienced PR,3 patients experienced SD,and 2 patients experienced PD.No significant differences in efficacy and complications were detected between the liver cancer ablation and liver cancer resection groups(P>0.05).After treatment,total bilirubin(41.24±7.35 vs 49.18±8.64μmol/L,P<0.001),alanine aminotransferase(30.85±6.23 vs 42.32±7.56 U/L,P<0.001),CD4+(43.95±5.72 vs 35.27±5.56,P<0.001),CD8+(20.38±3.91 vs 22.75±4.62,P<0.001),and CD4+/CD8+(2.16±0.39 vs 1.55±0.32,P<0.001)were significantly different between the liver cancer ablation and liver cancer resection groups.CONCLUSION The short-term efficacy and safety of microwave ablation and laparoscopic surgery for the treatment of liver cancer are similar,but liver function recovers quickly after microwave ablation,and microwave ablation may enhance immune function.

Paravertebral block's effect on analgesia and inflammation in advanced gastric cancer patients undergoing transarterial chemoembolization and microwave ablation

BACKGROUND Transarterial chemoembolization(TACE)combined with microwave ablation(MWA)is an effective treatment strategy for patients with advanced gastric cancer and liver metastasis.However,it may cause severe postoperative pain and inflammatory responses.The paravertebral block(PVB)is a regional anesthetic technique that provides analgesia to the thoracic and abdominal regions.AIM To evaluate the effect of PVB on postoperative analgesia and inflammatory response in patients undergoing TACE combined with MWA for advanced gastric cancer and liver metastasis.METHODS Sixty patients were randomly divided into PVB and control groups.The PVB group received ultrasound-guided PVB with 0.375%ropivacaine preoperatively,whereas the control group received intravenous analgesia with sufentanil.The primary outcome was the visual analog scale(VAS)score for pain at 6 h,12 h,24 h,and 48 h after the procedure.Secondary outcomes were the dose of sufentanil used,incidence of adverse events,and levels of inflammatory markers(white blood cell count,neutrophil percentage,C-reactive protein,and procalcitonin)before and after the procedure.RESULTS The PVB group had significantly lower VAS scores at 6 h,12 h,24 h,and 48 h after the procedure compared with the control group(P<0.05).The PVB group also had a significantly lower consumption of sufentanil and a lower incidence of nausea,vomiting,and respiratory depression than did the control group(P<0.05).Compared with the control group,the PVB group had significantly lower levels of inflammatory markers 24 h and 48 h after the procedure(P<0.05).CONCLUSION PVB can effectively reduce postoperative pain and inflammatory responses and improve postoperative comfort and recovery in patients with advanced gastric cancer and liver metastasis treated with TACE combined with MWA.

Past,present,and future perspectives of ultrasound-guided ablation of liver tumors:Where could artificial intelligence lead interventional oncology?

The first ablation procedures for small hepatocellular carcinomas were percutaneous ethanol injection under ultrasound(US)guidance.Later,radiofrequency ablation was shown to achieve larger coagulation areas than percutaneous ethanol injection and became the most used ablation technique worldwide.In the past decade,microwave ablation systems have achieved larger ablation areas than radiofrequency ablation,suggesting that the 3-cm barrier could be broken in the treatment of liver tumors.Likewise,US techniques to guide percutaneous ablation have seen important progress.Contrast-enhanced US(CEUS)can define and target the tumor better than US and can assess the size of the ablation area after the procedure,which allows immediate retreatment of the residual tumor foci.Furthermore,fusion imaging fuses real-time US images with computed tomography or magnetic resonance imaging with significant improvements in detecting and targeting lesions with low conspicuity on CEUS.Recently,software powered by artificial intelligence has been developed to allow three-dimensional segmentation and reconstruction of the anatomical structures,aiding in procedure planning,assessing ablation completeness,and targeting the residual viable foci with greater precision than CEUS.Hopefully,this could lead to the ablation of tumors up to 5-7 cm in size.

Effect of CT-Guided Microwave Ablation Combined with TACE on Liver Function and Survival of Patients with Primary Liver Cancer

Objective:To explore the effect of transarterial chemoembolization(TACE)+CT-guided microwave ablation(MWA)on treating patients with primary liver cancer.Methods:78 primary liver cancer cases were enrolled and divided into groups according to their assigned surgical plans.The control group was treated with TACE alone,and the observation group was treated with TACE+CT-guided MWA.The efficacy of the treatment and the liver function indicators and follow-up results of the patients of the two groups were compared.Results:The efficacy of the treatment received by the observation group was higher than that of the control group.Besides,the patients in the observation group exhibited better improvement in liver function indicators after 3 months of treatment.Furthermore,the survival rates of 1 and 2 years after surgery of the observation group were all higher than those of the control group(P<0.05).Conclusion:TACE combined with CT-guided MWA is more effective in treating primary liver cancer compared to TACE alone.Besides,it resulted in better improvement of liver function and long-term survival rate.Therefore,this treatment regime should be popularized.

Focal ablation therapy presents promising results for selectively localized prostate cancer patients

Due to its lower risk of consequences when compared to a radical approach, focal treatment is a viable and minimally invasive option for treating specific localized prostate cancer. Although several recent good nonrandomized trials have suggested that focused therapy may be an alternative choice for some patients, additional high-quality evidence is needed before it can be made widely available as a conventional treatment. As a result, we have summarized the most recent findings from the 38th Annual European Association of Urology Congress, one of the most renowned annual conferences in the area of urology, regarding focal ablation therapy for patients with localized prostate cancer. Additionally, we also provided clinical trials in progress for researchers to better understand the current research status of this field.

Uterine artery embolization combined with percutaneous microwave ablation for the treatment of prolapsed uterine submucosal leiomyoma:A case report

BACKGROUND Vaginal myomectomy is the most common form of radical treatment for prolapsed submucosal leiomyoma and is typically performed under general anesthesia.However,an alternative treatment approach is needed for patients who cannot tolerate general anesthesia.We describe a case with such a patient who was successfully treated via a minimally invasive method under local anesthesia.CASE SUMMARY A 46-year-old female suffered from abnormal uterine bleeding,severe anemia,and a reduced quality of life attributed to a massive prolapsed submucosal leiomyoma.She could not tolerate general anesthesia due to a congenital thoracic malformation and cardiopulmonary insufficiency.A new individualized combined treatment,consisting uterine artery embolization(UAE),percutaneous microwave ablation(PMWA)of the pedicle and the endometrium,and transvaginal removal of the leiomyoma by twisting,was performed.The lesion was completely removed successfully under local anesthesia without any major complications.The postoperative follow-up showed complete symptom relief and a significant improvement in the quality of life.CONCLUSION UAE combined with PMWA can be performed under local anesthesia and is a promising alternative treatment for patients who cannot tolerate general anesthesia.

LiNA OperaScope^(TM) for microwave endometrial ablation for endometrial polyps with heavy menstrual bleeding: A case report

BACKGROUND The procedure for microwave endometrial ablation(MEA)follows established MEA practice guidelines but requires hysteroscopic observation of the uterine lumen before and after MEA.When a luminal uterine lesion is recognized,its removal requires preoperative dilation of the cervix because the outer diameter of a conventional rigid hysteroscope is 8.7 mm.Recently,a fully disposable rigid hysteroscope(LiNA OperaScope^(TM))with a narrow diameter(4.4 mm)and forceps capable of extracting endometrial lesions has become available.CASE SUMMARY Here,we report a case of heavy menstrual bleeding(HMB)complicated by endometrial polyps where MEA was performed after removing endometrial polyps using the LiNA OperaScope^(TM) device.A 48-year-old woman with three prior pregnancies and three deliveries was referred to our hospital for further examination and treatment after being diagnosed with HMB 2 years earlier.The patient underwent MEA following endometrial polypectomy using LiNA OperaScope^(TM).After MEA,endometrial cauterization was again examined using the LiNA OperaScope^(TM),and the procedure was completed.No preoperative cervical dilation was performed.The patient’s clinical course was favorable,and she was discharged 3 h after surgery.One month after surgery,menstruation resumed,and both HMB and dysmenorrhea improved markedly from 10 preoperatively to 1 postoperatively,as assessed subjectively using the visual analog scale.The patient’s postoperative course was uneventful with no complic-ations.CONCLUSION LiNA OperaScope^(TM) can be a minimally invasive treatment for MEA of HMB with uterine lumen lesions.

Microwave ablation combined with transarterial chemoembolization containing doxorubicin hydrochloride liposome for treating primary and metastatic liver cancers

Aims:To determine the safety and efficacy of microwave ablation(MWA)and transarterial chemoembolization(TACE)with doxorubicin hydrochloride liposome(DHL)in patients with primary liver cancer(PLC)and metastatic liver cancer(MLC).Materials and methods:The medical records of patients with primary or metastatic liver cancer who underwent MWA combined with TACE containing DHL from March 2019 to March 2022 were collected and analyzed.Treatment-related adverse events(AEs)were recorded.Local tumor response was evaluated according to the modified RECIST criteria.Local tumor progression-free survival(LTPFS)and overall survival(OS)were calculated using the Kaplan-Meier method.Results:Altogether,96 patients with liver cancer were included(PLC,n=45;MLC,n=51).Forty(41.7%)patients experienced AEs during treatment,and eight(8.3%)patients developed grade 3 AEs.Compared to before treatment,the serum total bilirubin level and neutrophil to lymphocyte ratio significantly increased after treatment.The median LTPFS was 14.5 months in patients with PLC and 10.7 months in patients with MLC.The median OS was not reached in patients with PLC or MLC.The 1-month and 3-month disease control rates reached more than 80%in both groups.Conclusion:MWA combined with TACE with DHL may be a safe and effective method for the treatment of liver cancer.

Microwave ablation of solitary T1N0M0 papillary thyroid carcinoma:A case report

BACKGROUND The gold standard treatment for papillary thyroid carcinoma is total thyroidectomy and indications for microwave thermal ablation for primary thyroid cancers have not yet been clearly established However,some patients refuse surgery and others have no indication for it,for example patients under palliative care as in this case,or cannot undergo surgery,based on their comorbidities.These indications are described in the most recent Korean,North American and European guidelines.Laser ablation,radiofrequency ablation,and microwave ablation are similarly safe and effective,so the choice should be based on the specific competences and resources of the pertaining centers.These indications are Percutaneous minimally-invasive techniques;they can be useful to stop disease progression and as an alternative to surgery in patients with contraindication or who refuse surgery.We present a case of a thyroid papillary carcinoma with 17 mm effectively treated with microwave thermal ablation and without recurrence after one year of follow up.CASE SUMMARY The authors present a case of a 71-years-old patient with a left lobe papillary thyroid carcinoma with 13 mm×17 mm×13 mm,with no indication for thyroid surgery given the context of another cancer in palliative treatment.Microwave thermoablation was performed on December 2021.Four months later he repeated computed tomography(CT)scan,which showed that the tumor had disappeared.Six months after ablation he underwent a positron emission tomography/CT-fluorodeoxyglucose scan,which didn’t show any evidence of hypermetabolic tumor lesions.CONCLUSION This case shows microwave thermoablation can be a safe and effective alternative to surgery in patients with no conditions to undergo surgery or when they refuse it.By treating the tumor,with this minimally invasive technique,we are stopping its growth and avoiding disease progression.

Clinical Analysis of Transcatheter Arterial Chemoembolization Sequential Microwave Ablation Combined with Targeted Therapy and Immunotherapy in the Treatment of Large Hepatocellular Carcinoma

Objective: To investigate the safety and efficacy of Transcatheter Arterial Chemoembolization (TACE), sequential Microwave Ablation (MWA) combined with targeted therapy and immunotherapy versus TACE combined with targeted therapy and immunotherapy in the treatment of large hepatocellular carcinoma (defined as tumor diameter > 5 cm). Methods: The prospective cohort study was conducted, with 81 patients with large hepatocellular carcinoma who were admitted to Jingzhou Central Hospital from 2018 to 2022, they were divided into two groups, 41 patients received TACE sequential MWA combined with targeted therapy and immunotherapy (observation group), and 40 patients received single TACE combined with targeted therapy and immunotherapy (control group). The short-term efficacies after 3 months of treatment, the Disease Control Rate (DCR), the Overall Survival (OS), adverse drug reactions and complications were compared and analyzed between the two groups. Results: The Objective Response Rate (ORR) of the observation group was significantly higher than that of the control group (ORR: 85.4% vs 57.5%, P = 0.005), The median Progression-Free Survival (PFS) and median OS of the observation group were better than those of the control group (mPFS: 16 months vs 10 months, P = 0.004;mOS: 39 months. vs 24 months, P = 0.008). The 1-, 2- and 3-year progression-free survival rates of the observation group were 72.9%, 50.4%, and 25.6%, and those of the control group were 30.4%, 11.0%, and 3.7%. The 1-, 2- and 3-year overall survival rates of the observation group were 78.9%, 71.7%, and 65.2%, and those of the control group were 65.1%, versus 42.1% and 36.9%. There was no significant difference in the incidence of adverse drug reactions and complications between the two groups. In this study, the adverse drug reactions were mild in Grades 1 - 2. Conclusion: TACE sequential MWA combined with targeted therapy and immunotherapy has efficacy and safety.

Takotsubo Cardiomyopathy—A Rare but Serious Complication Following Microwave Ablation of the Liver—Case Report

Takotsubo cardiomyopathy is a form of stress cardiomyopathy which is reversible. It can clinically mimic an ST-segment elevation myocardial infarction. We present a case of a 63 year old female, who was diagnosed with takotsubo cardiomyopathy in the immediate postoperative period, following microwave ablation for a metastatic liver lesion. Despite takotsubo cardiomyopathy only accounting for a small percentage of acute coronary syndrome presentations, it is still an important differential to be considered when dealing with acute cardiac events, as the subsequent management is different as compared to the other more often encountered forms of acute cardiac events. .

Prognostic factors for survival after transarterial chemoembolization combined with microwave ablation for hepatocellular carcinoma

AIM: To analyze prognostic factors for survival after transarterial chemoembolization (TACE) combined with microwave ablation (MWA) for hepatocellular carcinoma (HCC).

Advances in local ablation of malignant liver lesions

Local ablation of liver tumors matured during the recent years and is now proven to be an effective tool in the treatment of malignant liver lesions. Advances focus on the improvement of local tumor control by technical innovations, individual selection of imaging modalities, more accurate needle placement and the free choice of access to the liver. Considering data found in the current literature for conventional local ablative treatment strategies, virtually no single technology is able to demonstrate an unequivocal superiority. Hints at better performance of microwave compared to radiofrequency ablation regarding local tumor control, duration of the procedure and potentially achievable larger size of ablation areas favour the comparably more recent treatment modality; image fusion enables more patients to undergo ultrasound guided local ablation; magnetic resonance guidance may improve primary success rates in selected patients; navigation and robotics accelerate the needle placement and reduces deviation of needle positions; laparoscopic thermoablation results in larger ablation areas and therefore hypothetically better local tumor control under acceptable complication rates, but seems to be limited to patients with no, mild or moderate adhesions following earlier surgical procedures. Apart from that, most techniques appear technically feasible, albeit demanding. Which technology will in the long run become accepted, is subject to future work.

Percutaneous ablation of pancreatic cancer

Pancreatic ductal adenocarcinoma is a highly aggressive tumor with an overall 5-year survival rate of less than 5%. Prognosis and treatment depend on whether the tumor is resectable or not, which mostly depends on how quickly the diagnosis is made. Chemotherapy and radiotherapy can be both used in cases of nonresectable pancreatic cancer. In cases of pancreatic neoplasm that is locally advanced, non-resectable, but non-metastatic, it is possible to apply percutaneous treatments that are able to induce tumor cytoreduction. The aim of this article will be to describe the multiple currently available treatment techniques(radiofrequency ablation, microwave ablation, cryoablation, and irreversible electroporation), their results, and their possible complications, with the aid of a literature review.

Effect of a poloxamer 407-based thermosensitive gel on minimization of thermal injury to diaphragm during microwave ablation of the liver

AIM To assess the insulating effect of a poloxamer 407(P407)-based gel during microwave ablation of liver adjacent to the diaphragm.METHODS We prepared serial dilutions of P407, and 22.5%(w/w) concentration was identified as suitable for ablation procedures. Subsequently, microwave ablations were performed on the livers of 24 rabbits(gel, saline, control groups, n = 8 in each). The P407 solution and 0.9% normal saline were injected into the potential space between the diaphragm and liver in experimental groups. No barriers were applied to the controls. After microwave ablations, the frequency, size and degree of thermal injury were compared histologically among the three groups. Subsequently, another 8 rabbits were injected with the P407 solution and microwave ablation was performed. The levels of alanine aminotransferase(ALT), aspartate aminotransferase(AST), blood urea nitrogen(BUN) and creatinine(Cr) in serum were tested at 1 d before microwave ablation and 3 and 7 d after operation. RESULTS In vivo ablation thermal injury to the adjacent diaphragm was evaluated in the control, saline and 22.5% P407 gel groups(P = 0.001-0.040). However, there was no significant difference in the volume of ablation zone among the three groups(P > 0.05). Moreover, there were no statistical differences among the preoperative and postoperative gel groups according to the levels of ALT, AST, BUN and Cr in serum(all P > 0.05).CONCLUSION Twenty-two point five percent P407 gel could be a more effective choice during microwave ablation of hepatic tumors adjacent to the diaphragm. Further studies for clinical translation are warranted.

Recurrence and survival following microwave, radiofrequency ablation, and hepatic resection of colorectal liver metastases: A systematic review and network meta-analysis

Background: Gold standard for colorectal liver metastases(CRLM) remains hepatic resection(HR). However, patients with severe comorbidities, unresectable or deep-situated resectable CRLM are candidates for ablation. The aim of the study was to compare recurrence rate and survival benefit of the microwave ablation(MWA), radiofrequency ablation(RFA) and HR by conducting the first network meta-analysis. Data sources: Systematic search of the literature was conducted in the electronic databases. Both updated traditional and network meta-analyses were conducted and the results were compared between them. Results: HR cohort demonstrated significantly less local recurrence rate and better 3-and 5-year diseasefree(DFS) and overall survival(OS) compared to MWA and RFA cohorts. HR cohort included significantly younger patients and with significantly lower preoperative carcinoembryonic antigen(CEA) by 10.28 ng/m L compared to RFA cohort. Subgroup analysis of local recurrence and OS of solitary and ≤3 cm CRLMs did not demonstrate any discrepancies when compared with the whole sample. Conclusions: For resectable CRLM the treatment of choice still remains HR. MWA and RFA can be used as a single or adjunct treatment in patients with unresectable CRLM and/or prohibitive comorbidities.

Experimental study of destruction to porcine spleen in vivo by microwave ablation

AIM: To discuss the safety, feasibility and regularity of destruction to porcine spleen in vivo with congestion and tumescence by microwave ablation (MWA). METHODS: Ligation of the splenic vein was used to induce congestion and tumescence in vivo in five porcine spleens, and microwave ablation was performed 2-4 h later. A total of 56 ablation points were ablated and the ablation powers were 30-100 W. The ablation time (1, 2, 3, 4, 5, 6, 7, 8, 9 and 10 min) was performed at a power of 60 W. After ablation, the ablation size was measured in pigs A, C, D and E and spleen resection. In pig B, the ablation size was measuredand 2 ablation points were sent for pathology analysis and all tissues were sutured following ablation. Pig B was killed 1 wk later and the ablation points were sent for pathology analysis. Bleeding, tissue carbonization surrounding electrodes, and pathological changes were observed, and the effect on destruction volume relative to different ablation powers, times and positions was analyzed. RESULTS: The incidence of bleeding (only small amounts, < 20 mL) in the course of ablation was 5.4% (3/56) and was attributed to tissue carbonization surrounding electrodes, which also exhibited an incidence of 5.4% (3/56). The destruction volume was influenced by different ablation powers, times and points. It showed that the ablation lesion size increased with increased ablation time, from 1 to 10 min, when the ablation power was 60 W. Also, the ablation lesion size increased with the increase of ablation power, ranging from 30 to 100 W when the ablation time was set to 3 min. A direct correlation was seen between the destruction volume and ablation time by the power of 60 W (r = 0.97542, P < 0.0001, and also between the destruction volume and ablation powers at an ablation time of 3 min (r = 0.98258, P < 0.0001). The destruction volume of zone Ⅱ (the extra-2/3 part of the spleen, relative to the fi rst or second class vascular branches), which was near the hilum of the spleen, was noteably larger than the destruction volume of zoneⅠ(the intra-1/3 part of the spleen) which was distal from the hilum of the spleen (P = 0.0015). Pathological changes of ablation occurring immediately and 1 wk after MWA showed large areas of coagulation. Immediately following ablation, intact spleen tissues were observed in the areas of coagulation necrosis, mainly around arterioles, and there were no obvious signs of hydropsia and inflammation, while 1 wk following the ablation, the coagulation necrosis was well distributed and complete, as many nuclear fragmentations were detected, and there were obvious signs of hydropsia and inflammation.CONCLUSION: In vivo treatment of congestion and tumescence in the spleen using microwave ablation of water-cooled antenna is a safe and feasible method that is minimally invasive.

Laser ablation of liver tumors:An ancillary technique,or an alternative to radiofrequency and microwave?

Radiofrequency ablation(RFA) is currently the most popular and used ablation modality for the treatment ofnon surgical patients with primary and secondary liver tumors, but in the last years microwave ablation(MWA) is being technically improved and widely rediscovered for clinical use. Laser thermal ablation(LTA) is by far less investigated and used than RFA and MWA, but the available data on its effectiveness and safety are quite good and comparable to those of RFA and MWA. All the three hyperthermia-based ablative techniques, when performed by skilled operators, can successfully treat all liver tumors eligible for thermal ablation, and to date in most centers of interventional oncology or interventional radiology the choice of the technique usually depends on the physician's preference and experience, or technical availability. However, RFA, MWA, and LTA have peculiar advantages and limitations that can make each of them more suitable than the other ones to treat patients and tumors with different characteristics. When all the three thermal ablation techniques are available, the choice among RFA, MWA, and LTA should be guided by their advantages and disadvantages, number, size, and location of the liver nodules, and cost-saving considerations, in order to give patients the best treatment option.

Minimally invasive treatment of hepatic hemangioma by transcatheter arterial embolization combined with microwave ablation:A case report

BACKGROUND Hepatic hemangioma is the most common benign tumor of the liver.However,patients with large hemangiomas that cause compression symptoms or that are at risk of rupture may need further intervention.It is necessary to explore additional minimally invasive and personalized treatment options for hemangiomas.CASE SUMMARY A 47-year-old woman was diagnosed with a right hepatic hemangioma for more than 10 years.Abdominal contrast-enhanced computed tomography(CT)and contrast-enhanced ultrasound revealed that there was a large hemangioma in the right liver,with a size of approximately 95 mm×97 mm×117 mm.Due to the patient's refusal of surgical treatment,hepatic artery embolization was performed in the first stage.After 25 d of liver protection treatment,the liver function indexes decreased to normal levels.Then,ultrasound-guided microwave ablation of the giant hepatic hemangioma was performed.Ten days after the treatment,hepatobiliary ultrasonography showed that the hemangioma of the right liver was smaller than the previous size(the volume was reduced by approximately 30%).Then the patient was discharged from the hospital.One year after discharge,CT showed that the hepatic hemangioma had shrunk by about 80%CONCLUSION Transcatheter arterial embolization combined with microwave ablation is a safe and effective minimally invasive treatment for hepatic hemangioma.