Korean J Radiol.  2013 Apr;14(2):248-258. 10.3348/kjr.2013.14.2.248.

Radiofrequency Ablation Combined with Chemoembolization for Intermediate-Sized (3-5 cm) Hepatocellular Carcinomas Under Dual Guidance of Biplane Fluoroscopy and Ultrasonography

• Min JH
• Lee MW
• Cha DI
• Jeon YH
• Shin SW
• Cho SK
• Rhim H
• Lim HK

• KMID: 1482784
• DOI: http://doi.org/10.3348/kjr.2013.14.2.248

Abstract

OBJECTIVE
To assess the technical feasibility and local efficacy of percutaneous radiofrequency ablation (RFA) combined with transcatheter arterial chemoembolization (TACE) for an intermediate-sized (3-5 cm in diameter) hepatocellular carcinoma (HCC) under the dual guidance of biplane fluoroscopy and ultrasonography (US).
MATERIALS AND METHODS
Patients with intermediate-sized HCCs were treated with percutaneous RFA combined with TACE. RFA was performed under the dual guidance of biplane fluoroscopy and US within 14 days after TACE. We evaluated the rate of major complications on immediate post-RFA CT images. Primary technique effectiveness rate was determined on one month follow-up CT images. The cumulative rate of local tumor progression was estimated with the use of Kaplan-Meier method.
RESULTS
Twenty-one consecutive patients with 21 HCCs (mean size: 3.6 cm; range: 3-4.5 cm) were included. After TACE (mean: 6.7 d; range: 1-14 d), 20 (95.2%) of 21 HCCs were visible on fluoroscopy and were ablated under dual guidance of biplane fluoroscopy and US. The other HCC that was poorly visible by fluoroscopy was ablated under US guidance alone. Major complications were observed in only one patient (pneumothorax). Primary technique effectiveness was achieved for all 21 HCCs in a single RFA session. Cumulative rates of local tumor progression were estimated as 9.5% and 19.0% at one and three years, respectively.
CONCLUSION
RFA combined with TACE under dual guidance of biplane fluoroscopy and US is technically feasible and effective for intermediate-sized HCC treatment.

Keyword

Hepatocellular carcinoma; Radiofrequency ablation; Transcatheter arterial chemoembolization; Fluoroscopy; Ultrasonography

MeSH Terms

Aged
Antibiotics, Antineoplastic/administration & dosage
Antineoplastic Agents/administration & dosage
Carcinoma, Hepatocellular/*drug therapy/radiography/*surgery/ultrasonography
Catheter Ablation/*methods
Chemoembolization, Therapeutic/*methods
Combined Modality Therapy
Disease Progression
Doxorubicin/administration & dosage
Ethiodized Oil/administration & dosage
Feasibility Studies
Female
Fluoroscopy
Humans
Liver Neoplasms/*drug therapy/radiography/*surgery/ultrasonography
Male
Postoperative Complications
*Radiography, Interventional
Retrospective Studies
Tomography, X-Ray Computed
Treatment Outcome
*Ultrasonography, Interventional
Antibiotics, Antineoplastic
Antineoplastic Agents
Doxorubicin
Ethiodized Oil

Figure

• 

  Fig. 1 69-year-old female with hepatocellular carcinoma (HCC) of liver. A. Axial arterial phase T1 weighted image (repetition time/echo time, 4.4/2.1 ms) shows 3 cm-sized enhancing HCC (arrowheads) in segment 5 of liver. B. On planning sonography for radiofrequency ablation (RFA) obtained 7 d after MR imaging, index tumor is seen as heterogeneous, low-echoic lesion (arrowheads). Index tumor measured 3.8 cm in longest diameter which is much larger than MR measurement (3.0 cm). C. After chemoembolization, near compact iodized oil has accumulated in tumor (arrowheads). D. RFA was performed 2 weeks after chemoembolization. To minimize thermal injury to adjacent abdominal wall, 500 mL of artificial ascites was introduced immediately before RFA procedure. Anteroposterior (superior images) and its corresponding lateral (inferior images) fluoroscopic images show electrodes obliquely placed in index tumor with retained iodized oil. Total of 9 overlapping ablations were performed using retained iodized oil, as Anatomic landmark. Retained iodized oil remained almost unchanged through multiple overlapping treatments. Total ablation time was 32 min. E. On sonography after initial electrode placement, echogenicity of index tumor (arrowheads) is slightly increased compared to that of on planning ultrasonography. Electrode was inserted until exposed tip (arrows) passed through tumor, enough to obtain sufficient ablative margin. F. After ablating upper part of index tumor (black asterisk), electrode tip and margin of tumor was invisible due to echogenic zone produced by prior ablations. In addition, margin of lower part of tumor not yet ablated (white asterisk), is also obscured by echogenic zone and its shadow. G. Portal venous phase axial CT image obtained immediately after RFA shows HCC with iodized oil retention (arrow) and nonenhancing area surrounding tumor (arrowheads), indicating technical success.

• 

  Fig. 2 Local tumor progression rate of 21 hepatocellular carcinomas after combined chemoembolization and radiofrequency ablation. Cumulative rates of local tumor progression were estimated as 9.5% and 19.0% at 1 and 3 years, respectively '+' marks indicate censored data.

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