Computed Tomographic-Guided Radiofrequency Ablation of Recurrent or Residual Hepatocellular Carcinomas around Retained Iodized Oil after Transarterial Chemoembolization

Abstract

ObjectiveTo assess the clinical efficacy, safety, and risk factors influencing local tumor progression, following CT-guided radiofrequency ablation (RFA) of recurrent or residual hepatocellular carcinoma (HCC), around iodized oil retention.Materials and MethodsSixty-four patients (M : F = 51 : 13, 65.0 ± 8.2 years old) with recurrent or residual HCC (75 index tumors, size = 14.0 ± 4.6 mm) had been treated by CT-guided RFA, using retained iodized oil as markers for targeting. The technical success, technique effectiveness rate and complications of RFA were then assessed. On pre-ablative and immediate follow-up CT after RFA, we evaluated the size of enhancing index tumors and iodized oil retention, presence of abutting vessels, completeness of ablation of iodized oil retention, and the presence of ablative margins greater than 5 mm. Also, the time interval between transarterial chemoembolization and RFA was assessed. The cumulative local tumor progression rate was calculated using the Kaplan-Meier method, and the Cox proportional hazards model was adopted, to clarify the independent factors affecting local tumor progression.ResultsThe technical success and technique effectiveness rate was 100% and 98.7%, respectively. Major complications were observed in 5.6%. The cumulative rates of local tumor progression at 1 and 2 years were 17.5% and 37.5%, respectively. In multivariate analyses, partial ablation of the targeted iodized oil retention was the sole independent predictor of a higher local tumor progression rate.ConclusionCT-guided RFA of HCC around iodized oil retention was effective and safe. Local tumor progression can be minimized by complete ablation of not only index tumors, but targeted iodized oil deposits as well.

Computed tomography-guided radiofrequency ablation combined with transarterial embolization assisted by a three-dimensional visualization ablation planning system for hepatocellular carcinoma in challenging locations: a preliminary study

“…Koh et al evaluated the efficacy of CT-guided RFA for recurrent or residual HCC around the retained iodized oil after TACE in 64 patients with 75 viable HCCs. The authors reported 1-and 2-year LTP rates of 17.5% and 37.5%, respectively [30], which was higher than the 13.8% and 20.6% LTP rate after TAE combined with RFA in our study. This result appears to be attributed to the important role of preoperative planning in 3DVAPS.…”

Comparison of Combined Transcatheter Arterial Chemoembolization and CT-guided Radiofrequency Ablation with Surgical Resection in Patients with Hepatocellular Carcinoma within the Up-to-seven Criteria: A Multicenter Case-matched Study

“…The difference between the survival benefits of these two therapeutic modalities remains unclear. Moreover, with the merit of high resolution and without interference of gas released during the procedure, the use of CT guidance in the RFA procedure helps operators to ablate even large tumors with a safety margin greater than that with the widely used ultrasonographic guidance 6 , 13 . The aim of this work was to compare the safety and efficacy of TACE in combination with available CT-guided RFA with that of SR in patients with HCC who met the up-to-seven criteria in a large multicenter case-matched study.…”

C-Arm Cone Beam Computed Tomography Guidance for Radiofrequency Ablation in Hepatocellular Carcinoma

“…However, a combination of ultrasound guidance, a volume navigation system with fusion of ultrasound/CT or ultrasound/MRI images, and C-arm CBCT has not been reported. In conventional CT-guided RFA, pneumothorax was noted in 9 out of 71 patients (12.7%) [38], which compares poorly with the corresponding 3 out of 198 cases (1.5%) in this study. As we described, the electrode was first inserted into the target lesion under ultrasound guidance - or by using the volume navigation system with fusion images, if necessary.…”

“…In previous reports, electrode insertion was guided by C-arm CBCT with integrated navigation software [19,20] or standard CT alone [35,36,37,38]. However, a combination of ultrasound guidance, a volume navigation system with fusion of ultrasound/CT or ultrasound/MRI images, and C-arm CBCT has not been reported.…”