Multibipolar Radiofrequency Ablation for the Treatment of Mass-Forming and Infiltrative Hepatocellular Carcinomas > 5 cm: Long-Term Results

Abstract

Aims and Background: Only few patients with cirrhosis and hepatocellular carcinoma (HCC) larger than 5 cm are amenable to resection or straight liver transplantation, and in such circumstances, multibipolar radiofrequency ablation (mbp-RFA) could be a reliable alternative. This study was aimed to assess the long-term outcome in patients treated with mbp-RFA for unresectable HCC > 5 cm. Methods: Eighty-three consecutive patients with cirrhosis (median age 70 years [37–93 years], 67 males, BCLC A/B/C: 54/21/8, 74 naive) with up to three HCCs, the largest > 5 cm in diameter (median: 6.2 cm, 5.1–9 cm, 22 infiltrative forms, 12 with segmental portal invasion of which 10 were infiltrative forms) were treated with mbp-RFA. Overall (OS) and recurrence-free (RFS) survival and their associated predictive factors were assessed. Results: Complete ablation was observed in 78/83 (94%) patients. Thirty-one side effects occurred, including 6 (7%) severe complications. After a median follow-up of 26.1 months (1–112 months), in naive patients the 3- and 5-year OS was 51% (38–62) and 24% (13–36), 63 and 30% for mass-forming and 25 and 6% for infiltrative form, respectively. Infiltrative form (HR: 2.5 [1.33–4.69], p = 0.004) was the only independent OS predictor. In naive patients with mass-forming and infiltrative form, the 3- and 5-year RFS were 47 and 17 and 18 and 18%, respectively. Alpha-fetoprotein (HR: 2.86 [1.32–6.21], p = 0.008), multinodular form (HR: 2.74 [1.4–5.38], p = 0.003) and infiltrative form (HR: 3.43 [1.67–7.01], p = 0.0007) were independent RFS predictors. Conclusions: mbp-RFA offers good OS in inoperable patients with cirrhosis and large HCC, with acceptable safety profile. For infiltrative forms, although mbp-RFA leads to complete responses in more than 80% cases, few only remain tumor progression-free in long-term.

Influence of interapplicator distance on multibipolar radiofrequency ablation during physiological and interrupted liver perfusion in an in vivo porcine model

“…Although, mbRFA seems to be a more complex procedure in comparison to mono-or bipolar RFA, this technique represents a promising therapeutic option in order to overcome some limitations of conventional RFA 9,13 . In regard to local tumour control, mbRFA is even considered superior to other minimally invasive therapies such as MWA used for treating HCC ≤ 5 cm 30 .…”

“…Studies showed that no-touch mbRFA reduces the risk of needle track seeding and moreover, is able to assure an adequate peritumoral safety margin [9][10][11] . As larger ablation areas are achieved, no-touch mbRFA is also becoming a promising option for the curative treatment of HCC > 5 cm [12][13][14] . However, interapplicator distance may play an important role in order to generate a sufficient ablation area 15 .…”

Optimizing curative management of hepatocellular carcinoma

“…The main consequence for clinical application is better prediction of the boundaries of the ablation zone by the centripetal mode compared to the centrifugal mode,which implies a limited diffusion of energy outside of the applicators. Thus, indications for ablation can be extended to larger tumours (up to 8 cm) with centripetal energy devices, even infiltrative tumours with limited portal invasion (Vp1‐3) . For standard indications (tumour <5 cm), the no‐touch approach can be implemented with centripetal methods, especially multibipolar RFA, which involves inserting applicators outside the tumour (extratumourous method).…”

“…Thus, indications for ablation can be extended to larger tumours (up to 8 cm) with centripetal energy devices, even infiltrative tumours with limited portal invasion (Vp1-3). 20 For standard indications (tumour <5 cm), the no-touch approach can be implemented with centripetal methods, especially multibipolar RFA, which involves inserting applicators outside the tumour (extratumourous method). The local recurrence rate in HCC up to 5 cm (including for those <3 cm) is markedly decreased with no-touch multibipolar RFA compared to monopolar RFA.…”

Stereotactic Body Radiotherapy Combined with Transcatheter Arterial Chemoembolization versus Stereotactic Body Radiotherapy Alone as the First-Line Treatment for Unresectable Hepatocellular Carcinoma: A Meta-Analysis and Systematic Review

“…TACE has acceptable shortterm efficiency, but its long-term efficiency is poor [11]. The 2018 National Comprehensive Cancer Network guidelines and the 2018 American Association for the Study of Liver Diseases guidelines indicate that SBRT can be used as an alternative to radiofrequency ablation/ TACE in unresectable HCC [2,8,12]. The strategy of combining SBRT and TACE (ST) is an emerging treatment for unresectable HCC patients.…”