Korean J Radiol.  2012 Feb;13(Suppl 1):S104-S111. 10.3348/kjr.2012.13.S1.S104.

Effect of Ultrasound-Guided Radiofrequency Ablation in Incompletely Treated Hepatocellular Carcinoma after Transcatheter Arterial Chemoembolization

• Chang NK
• Shin SS
• Kim JW
• Kim HJ
• Jeong YY
• Heo SH
• Kim JK
• Kang HK

• KMID: 1372875
• DOI: http://doi.org/10.3348/kjr.2012.13.S1.S104

Abstract

OBJECTIVE
To evaluate the effectiveness of ultrasound-guided radiofrequency (RF) ablation in patients with incompletely treated hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) and to evaluate possible prognostic factors for this therapy.
SUBJECTS AND METHODS
Thirty nine patients with incompletely treated single HCC (< or = 5 cm) after TACE were treated with RF ablation. All patients were evaluated for complete tumor ablation rate, local recurrence-free rate, overall survival rate, and complications. Local recurrence-free rate and overall survival rate were calculated using the Kaplan-Meier method. The possible prognostic factors of local recurrence-free rate and survival rate were analyzed using Cox proportional-hazards regression model.
RESULTS
The complete tumor ablation rate was 92.3%. Local recurrence-free rates for 1-, 2-, 3-, and 5-years were 81.7%, 63.1%, 53.6%, and 35.7%, respectively. One-, 2-, 3-, and 5-year overall survival rates were 96.9%, 82.9%, 67.8%, and 48.4%, respectively. Among prognostic factors included in the analysis, only tumor diameter (< or = 2 cm versus > 2 cm) was statistically significant in terms of predicting local recurrence. Complications were observed in two patients, one with liver abscess and the other with portal venous thrombosis.
CONCLUSION
Ultrasound-guided RF ablation could be effective and safe in treating incompletely treated HCC after TACE. The diameter of HCC was a significant prognostic factor for local recurrence.

Keyword

Hepatocellular carcinoma; Radiofrequency ablation; Transcatheter arterial chemoembolization

MeSH Terms

Aged
Aged, 80 and over
Carcinoma, Hepatocellular/pathology/*therapy/ultrasonography
Catheter Ablation/*methods
Chemoembolization, Therapeutic/*methods
Combined Modality Therapy
Female
Humans
Liver Neoplasms/pathology/*therapy/ultrasonography
Male
Middle Aged
Neoplasm Recurrence, Local
Postoperative Complications
Prognosis
Proportional Hazards Models
Treatment Outcome
*Ultrasonography, Interventional

Figure

• 

  Fig. 1 3 cm HCC in 66-year-old woman with no local recurrence during long term follow-up (3 years). A. Axial arterial-phase CT scan obtained before RF ablation shows early enhancement (arrow) in sparsely lipiodol uptake HCC after TACE. B. Axial arterial-phase CT scan obtained 1 hour after RF ablation shows ablation zone (arrow) with surrounding rim of benign enhancement. C-F. Axial arterial-phase CT scans from 1-month (C), 1-year (D), 2-year (E) and 3-year (F) follow-ups show progressive involution of ablation zone without local recurrence (arrow). HCC = hepatocellular carcinoma, TACE = transcatheter arterial chemoembolization, RF = radiofrequency

• 

  Fig. 2 3.8 cm HCC in 48-year-old man with incomplete tumoral necrosis. A. Axial arterial-phase CT scan obtained before RF ablation shows early enhancement (arrows) in defective lipiodol uptake HCC after TACE. B. Axial arterial-phase CT scan obtained 1 hour after RF ablation shows irregular perilesional enhancement (arrows). C. Axial arterial-phase CT scan obtained 1 month after RF ablation shows disappearance of perilesional enhancement (arrows). D. CT scan obtained at more superior level than C shows enhancing portion (arrowhead) at periphery of ablation zone, which was subsequently treated with TACE. HCC = hepatocellular carcinoma, TACE = transcatheter arterial chemoembolization, RF = radiofrequency

• 

  Fig. 3 Graph illustrates local recurrence free rate. 1-, 2-, 3-, and 5-year local recurrence free rates were 81.7%, 63.1%, 53.6%, and 35.7%, respectively.

• 

  Fig. 4 Graph illustrates overall survival rate. 1-, 2-, 3-, and 5-year overall survival rates were 96.9%, 82.9%, 67.8%, and 48.4%, respectively.

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