<p><b><i>Objective:</i></b> To assess the usefulness of C-arm cone beam
computed tomography (CBCT) combined with ultrasound for the treatment of
hepatocellular carcinoma (HCC) by radiofrequency ablation (RFA). <b><i>Methods:</i></b>
Patients underwent RFA following transcatheter arterial
chemoembolization (TACE) or RFA alone under ultrasound or CBCT guidance
combined with ultrasound-based techniques. They were divided into 2
groups based on the use (C group) and nonuse (NC group) of CBCT
guidance. The technical success of RFA and local tumor progression after
the first RFA session were evaluated by dynamic contrast-enhanced
imaging methods. Between-group differences were assessed
retrospectively. <b><i>Results:</i></b> We enrolled 198 patients with
260 HCC nodules. The complete ablation rates were 63.0 and 89.4% in the
NC and C groups, respectively. In log-rank testing, local tumor
progression occurred significantly more often in the NC group when RFA
was used without TACE, in males when des-gamma-carboxy prothrombin was
≥29 mAU/mL, and when the diameter of a nodule was ≥18 mm. On Cox
proportional-hazards regression analysis, the NC group, RFA alone
without TACE, and male gender were significant independent variables. <b><i>Conclusion:</i></b>
TACE followed by RFA under CBCT and ultrasound guidance improves the
reliability of ablation of target HCC nodules, reduces the need for
additional treatment sessions, and prevents local tumor progression.</p