Radiofrequency ablation of surface v/s intraparenchymal hepatocellular carcinoma in cirrhotic patients

Yashwant Patidar; Praveen Singhal; Shailesh Gupta; Amar Mukund; Shiv K Sarin

doi:10.4103/ijri.IJRI_490_16

Indian Journal of Radiology and Imaging, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2017; 27(04): 496-502
DOI: 10.4103/ijri.IJRI_490_16

Intervention

Radiofrequency ablation of surface v/s intraparenchymal hepatocellular carcinoma in cirrhotic patients

Authors

Yashwant Patidar

Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
Praveen Singhal

Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
Shailesh Gupta

Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
Amar Mukund

Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
Shiv K Sarin

Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India

Abstract

als PDF herunterladen

Abstract

Objective: To retrospectively evaluate the safety and technical efficacy of percutaneous radiofrequency ablation (RFA) of surface hepatocellular carcinoma (HCC) in comparison to intraparenchymal HCC in cirrhotic patients. Materials and Methods: Surface lesions were defined as tumours located or reaching within 1cm of liver capsule including exophytic lesions. Seventy-four surface HCC including 21 exophytic in 58 patients (surface group) and 60 intraparenchymal HCC in 54 patients (intraparenchymal group) measuring up to 4 cm in maximum extent underwent percutaneous [ultrasound (US) or computed tomography-guided (CT-guided)] RFA. The response to the treatment was assessed by contrast enhanced CT/magnetic resonance imaging (MRI) done at 1, 3, 6, 9, and 12 months of RFA and thereafter every 4–6 months. In case of features suggesting residual disease, a repeat RFA was performed. The technical success after single-session RFA, complications and disease recurrence rates were calculated and compared between two groups. Results: Technical success achieved after first session of RFA in surface HCC was 95% (70/74) and intraparenchymal HCC was 97% (58/60). Hundred percent secondary success rate was achieved in both groups after second repeat RFA in residual lesion. No major difference in complication and local recurrence rate in both group on follow-up in surface HCC and intraparenchymal HCC. No case of needle track, peritoneal seeding, and treatment mortality was found. Conclusions: The complication rate and efficacy of RFA for surface and exophytic HCC's were comparable to that of intraparenchymal HCC. Hence surface and exophytic lesions should not be considered a contraindication for RFA in cirrhotic patients.

Keywords

Cirrhotic patients - hepatocellular carcinoma - intraparenchymal - radiofrequency ablation - surface

PDF (1089 kb)

Referenzen

References
1 Fong Y, Sun RL, Jarnagin W, Blumgart LH. An analysis of 412 cases of hepatocellular carcinoma at a Western center. Ann Surg 1999;229:790-9.
2 Poon RT, Fan ST, Tsang FH, Wong J. Locoregional therapies for hepatocellular carcinoma: A critical review from the surgeon's perspective. Ann Surg 2002;235:466-86.
3 Lau WY, Lai EC. The current role of radiofrequency ablation in the management of hepatocellular carcinoma: A systematic Review. Ann Surg 2009;249:20-5.
4 Komorizono Y, Oketani M, Sako K, Yamasaki N, Shibatou T, Maeda M, et al. Risk factors for local recurrence of small hepatocellular carcinoma tumors after a single session, single application of percutaneous radiofrequency ablation. Cancer 2003;97:1253-62.
5 Hori T, Nagata K, Hasuike S, Onaga M, Motoda M, Kato J, et al. Risk factor for the local recurrence of hepatocellular carcinoma after a single session of percutaneous radiofrequency ablation. J Gastroenterol 2003;38:977-81.
6 Llovet JM, Vilana R, Bru C, Salmeron JM, Sala M, Sole M, et al. Increased risk of tumor seeding after percutaneous radiofrequency ablation for single hepatocellular carcinoma. Hepatology 2001;33:1124-9.
7 Jaskolka JD, Asch MR, Kachura JR, Ho CS, Ossip M, Wong F, et al. Needle tract seeding after radiofrequency ablation of hepatic tumors. J Vasc Interv Radiol 2005;16:485-91.
8 Livraghi T. Tumor dissemination after radiofrequency ablation of hepatocellular carcinoma. Hepatology 2001;34:608-9.
9 Ahmed M, Solbiati L, Brace CL, Breen DJ, Callstrom MR, Leen E, et al. Image-guided tumor ablation: Standardization of terminology and reporting criteria-a 10-year update. Radiology 2014;273:241-60.
10 Livraghi T, Solbiati L, Meloni MF, Gazelle GS, Halpern EF, Goldberg SN. Treatment of focal liver tumors with percutaneous radiofrequency ablation: Complications encountered in a multicenter study. Radiology 2003;226:441-51.
11 Rhim H, Yoon KH, Lee JM, et al. Major complications after radiofrequency thermal ablation of hepatic tumors: Spectrum of imaging findings. Radiographics 2003;23:123-34.
12 Meloni MF, Goldberg SN, Moser V, Piazza G, Livraghi T. Colonic perforation and abscess following radiofrequency ablation treatment of hepatoma. Eur J Ultrasound 2002;15:73-6.
13 Mulier S, Mulier P, Ni Y, Miao Y, Dupas B, Marchal G, et al. Complications of radiofrequency coagulation of liver tumors. Br J Surg 2002;89:1206-22.
14 Poon RT, Ng KK, Lam CM, Ai V, Yuen J, Fan ST. Radiofrequency ablation for subcapsular hepatocellular carcinoma. Ann Surg Oncol 2004;11:281-9.
15 Goldberg SN, Solbiati L. Tumor dissemination after radiofrequency ablation of hepatocellular carcinoma [letter]. Hepatology 2001;34:609.
16 De Sio I, Castellano L, De Girolamo V, di Santolo SS, Marone A, Marone G, et al. Tumor dissemination after radiofrequency ablation of hepatocellular carcinoma [letter]. Hepatology 2001;34:609-10.
17 Cho YK, Rhim H, Ahn YS, Kim MY, Lim HK. Percutaneous radiofrequency ablation therapy of hepatocellular carcinoma using multitined expandable electrodes: Comparison of subcapsular and nonsubcapsular tumors. AJR Am J Roentgenol 2006;186:S269-74.
18 Sartori S, Tombesi P, Macario F, Nielsen I, Tassinari D, Catellani M, et al. Subcapsular liver tumors treated with percutaneous radiofrequency ablation: A prospective comparison with nonsubcapsular liver tumors for safety and effectiveness. Radiology 2008;248:670-9.
19 Kim YJ, Raman SS, Yu NC, Busuttil RW, Tong M, Lu DS. Radiofrequency ablation of hepatocellular carcinoma: Can subcapsular tumors be safely ablated? AJR Am J Roentgenol 2008;190:1029-34.
20 Kang TW, Lim KH, Lee MW, Kim YS, Rhim H, Lee WJ, et al. Long term therapeutic outcome of radiofrequency ablation of subcapsular versus nonsabcapsular heaptocellular carcinoma: A Propensity Score Matched Study. Radiology 2016;280:300-12.