Radiofrequency Ablation Combined with Chemoembolization for the Treatment of Hepatocellular Carcinomas 5 cm or Smaller: Risk Factors for Local Tumor Progression

OBJECTIVE: To retrospectively evaluate the safety and short-term therapeutic efficacy of radiofrequency ablation (RFA) with a multiple-electrode switching system (MESS) to treat medium-sized (3.1-5.0 cm) hepatocellular carcinomas (HCCs). SUMMARY OF BACKGROUND DATA: Conventional monopolar RFA is limited in achieving local control for tumors larger than 3 cm. Therefore, MESS-RFA was developed, and can create a sufficiently large ablation volume including the target tumor and a 5−10 mm safety margin in medium-sized tumors METHODS: We performed a total of 168 RFAs with a MESS on 166 patients. The patients were treated under ultrasonographic guidance by percutaneous switching system RFA with a multichannel RF generator and two or three internally cooled electrodes. Technical effectiveness, local progression, and remote recurrence of HCC were determined. RESULTS: For the 166 isolated HCC tumors, the complete ablation rate of MESS-RFA was 98.79% (164/166). Mean ablation time per procedure was 12.33±3.01 min; mean ablation diameter was 5.79±0.61 cm. The complication rate was 2.41%. During follow-up (averaging 16.54 months), local tumor progression occurred in 15/166 patients (9.03%) with technical effectiveness, while new HCCs were detected in 40/166 patients (24.09%). Multivariate analyses revealed that local tumor progression was only associated with serum AFP levels above 100 ng/ml as a risk factor. CONCLUSION: MESS-RFA for achieving sufficient ablation volume is safe and efficient. This method also showed relatively successful therapeutic effectiveness on short-term follow up in the treatment of medium-sized HCCs.

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Comparative Analysis of Radiofrequency Ablation and Microwave Ablation for Critically Located Hepatocellular Carcinomas Smaller than 5 cm

Journal of Clinical Interventional Radiology ISVIR ◽

10.1055/s-0041-1723050 ◽

2021 ◽

Author(s):

Ravindran Ramalingam ◽

Amar Mukund ◽

Karan Manoj Anandpara ◽

Yashwant Patidar ◽

Shiv Kumar Sarin

Keyword(s):

Radiofrequency Ablation ◽

Tumor Progression ◽

Microwave Ablation ◽

Treatment Effectiveness ◽

Local Tumor Progression ◽

Local Tumor ◽

Hepatocellular Carcinomas ◽

Critical Location ◽

Critical Locations

Abstract Purpose To compare the safety and efficacy of radiofrequency ablation (RFA) versus microwave ablation (MWA) for hepatocellular carcinomas (HCC) smaller than 5 cm in critical locations. Methods Single-center retrospective study of all patients who underwent RFA/MWA for HCC from July 2015 to Dec 2019. Critical location includes exophytic tumors, tumors ≤ 5 mm from the diaphragm, heart, gallbladder, kidney, gastrointestinal tract, and ≤ 10 mm from large vessels with caliber of ≥ 3 mm. Treatment effectiveness, local tumor progression, and complication rates were evaluated. Results Out of 119 patients with 147 HCC nodules in critical location, 65 (M:F = 49:16; mean age–61.7) were included in RFA group and 54 (M:F =43:11; mean age–60.5) in MWA group. Mean follow-up period was 16.5 and 14.8 months, respectively. At first follow-up imaging, 66/78 tumors in RFA group and 57/69 tumors in MWA group showed complete ablation with primary treatment effectiveness rates of 84.6% and 82.6%, respectively (p = 0.741). Local tumor progression (LTP) rate was 21.8% (17/78) and 20.3% (14/69), respectively (p = 0.826). Median time to LTP was 12 and 13.5 months, respectively. Fourteen tumors in RFA group and 12 in MWA group underwent reablation with a secondary treatment effectiveness rates of 78.6% (14/17) and 83.3% (12/14), respectively (p = 0.757). Mean LTP-free survival was 37.2 and 28.1 months, respectively. The total complication rate was 36.9% and 31.5%, respectively (p = 0.535) with no major complications in both the groups. Conclusion Our data suggest that both MWA and RFA are equally safe and effective for treating HCCs < 5 cm in critical locations.

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Diagnostic accuracy of different magnetic resonance imaging sequences for detecting local tumor progression after radiofrequency ablation of hepatic malignancies

European Journal of Radiology ◽

10.1016/j.ejrad.2017.06.009 ◽

2017 ◽

Vol 94 ◽

pp. 85-92 ◽

Cited By ~ 1

Author(s):

Jakob Weiss ◽

Hansjoerg Rempp ◽

Stephan Clasen ◽

Mike Notohamiprodjo ◽

David-Emanuel Keßler ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Radiofrequency Ablation ◽

Magnetic Resonance ◽

Diagnostic Accuracy ◽

Tumor Progression ◽

Local Tumor Progression ◽

Resonance Imaging ◽

Local Tumor ◽

Hepatic Malignancies

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Radiofrequency Ablation of Hepatic Metastases: Factors Influencing Local Tumor Progression

Annals of Surgical Oncology ◽

10.1245/s10434-014-3738-y ◽

2014 ◽

Vol 21 (9) ◽

pp. 3090-3095 ◽

Cited By ~ 6

Author(s):

Chang-Hsien Liu ◽

Chih-Yung Yu ◽

Wei-Chou Chang ◽

Ming-Shen Dai ◽

Cheng-Wen Hsiao ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Tumor Progression ◽

Hepatic Metastases ◽

Local Tumor Progression ◽

Local Tumor ◽

Factors Influencing

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Combination of radiofrequency ablation and transcatheter arterial chemoembolization to treat hepatocellular carcinoma: measurement of distance from needle tip to nodule for assessment of local tumor progression

Journal of International Medical Research ◽

10.1177/0300060519844667 ◽

2019 ◽

Vol 47 (6) ◽

pp. 2516-2523 ◽

Cited By ~ 1

Author(s):

Wang Haochen ◽

Wang Jian ◽

Song Li ◽

Lv Tianshi ◽

Tong Xiaoqiang ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Prognostic Factors ◽

Radiofrequency Ablation ◽

Tumor Progression ◽

Minimum Distance ◽

Transcatheter Arterial Chemoembolization ◽

Three Dimensional ◽

Local Tumor Progression ◽

Local Tumor ◽

Arterial Chemoembolization

Objective This study was performed to determine the relationship between the minimum distance from the radiofrequency ablation (RFA) needle tip to the tumor and local tumor progression (LTP) of hepatocellular carcinoma (HCC) nodules and identify prognostic factors for LTP. Methods We reviewed 197 patients (197 nodules) who underwent RFA after transcatheter arterial chemoembolization for HCC from January 2010 to January 2015. Three-dimensional registration of images was used to calculate the minimum distance from the tip to the tumor. We then divided the minimum distance into two groups: <2 and ≥2 mm. Contrast-enhanced computed tomography was performed after treatment. The LTP rate was calculated 1 and 3 years after RFA. We performed multivariate analysis to identify independent prognostic factors for LTP. Results The cumulative 1-year LTP rates in the <2- and ≥2-mm groups were 82.7% and 4.3%, respectively, and the cumulative 3-year LTP rates in the two groups were 94.8% and 10.8%, respectively. The minimum distance from the needle tip to the tumor was an independent prognostic factor for LTP. Conclusions A minimum distance of 2 mm from the needle tip to the tumor should be completely ablated along with the tumor.

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