Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Radiofrequency Ablation for Viable Hepatocellular Carcinoma around Retained Iodized Oil after Transcatheter Arterial Chemoembolization: Usefulness of Biplane Fluoroscopy Plus Ultrasound Guidance

  • Min, Ji Hye (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Min Woo (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Rhim, Hyunchul (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Dongil (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Young-Sun (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Young Jun (Department of Radiology and Research Institute of Biomedical Science, Konkuk University School of Medicine) ;
  • Cha, Dong Ik (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lim, Hyo K. (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Published : 2012.12.01
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Abstract

Objective: To assess the technical feasibility and local efficacy of biplane fluoroscopy plus US-guided percutaneous radiofrequency ablation (RFA) for viable hepatocellular carcinoma (HCC) around retained iodized oil after transcatheter arterial chemoembolization (TACE). Materials and Methods: Our prospective study was approved by our institutional review board and informed consent was obtained from all participating patients. For patients with viable HCC around retained iodized oil after TACE, biplane fluoroscopy plus US-guided RFA was performed. We evaluated the rate of technical success and major complications on a post-RFA CT examination and local tumor progression with a follow-up CT. Results: Among 40 consecutive patients, 19 were excluded due to one of the following reasons: poorly visible HCC on fluoroscopy (n = 13), high risk location (n = 2), RFA performed under monoplane fluoroscopy and US guidance (n = 2), and poorly identifiable new HCCs on US (n = 2). The remaining 21 patients with 21 viable HCCs were included. The size of total tumors ranged from 1.4 to 5.0 cm (mean: 3.2 cm) in the longest diameter. Technical success was achieved for all 21 HCCs, and major complications were observed in none of the patients. During the follow-up period (mean, 20.3 months; range, 6.5-29.9 months), local tumor progression was found in two patients (2/21, 9.5%). Distant intrahepatic metastasis developed in 76.2% (16/21) of patients. Conclusion: When retained iodized oil around the tumor after TACE hampers the targeting of the viable tumor for RFA, biplane fluoroscopy plus US-guided RFA may be performed owing to its technical feasibility and effective treatment for viable HCCs.

Keywords

References

  1. Lo CM, Ngan H, Tso WK, Liu CL, Lam CM, Poon RT, et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 2002;35:1164-1171 https://doi.org/10.1053/jhep.2002.33156
  2. Saccheri S, Lovaria A, Sangiovanni A, Nicolini A, De Fazio C, Ronchi G, et al. Segmental transcatheter arterial chemoembolization treatment in patients with cirrhosis and inoperable hepatocellular carcinomas. J Vasc Interv Radiol 2002;13:995-999 https://doi.org/10.1016/S1051-0443(07)61863-6
  3. Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology 2003;37:429-442 https://doi.org/10.1053/jhep.2003.50047
  4. Bruix J, Sala M, Llovet JM. Chemoembolization for hepatocellular carcinoma. Gastroenterology 2004;127(5 Suppl 1):S179-S188 https://doi.org/10.1053/j.gastro.2004.09.032
  5. Decaens T, Roudot-Thoraval F, Bresson-Hadni S, Meyer C, Gugenheim J, Durand F, et al. Impact of pretransplantation transarterial chemoembolization on survival and recurrence after liver transplantation for hepatocellular carcinoma. Liver Transpl 2005;11:767-775 https://doi.org/10.1002/lt.20418
  6. Uchida H, Matsuo N, Sakaguchi H, Nagano N, Nishimine K, Ohishi H. Segmental embolotherapy for hepatic cancer: keys to success. Cardiovasc Intervent Radiol 1993;16:67-71 https://doi.org/10.1007/BF02602980
  7. Lee J, Lee JM, Yoon JH, Lee JY, Kim SH, Lee JE, et al. Percutaneous radiofrequency ablation with multiple electrodes for medium-sized hepatocellular carcinomas. Korean J Radiol 2012;13:34-43 https://doi.org/10.3348/kjr.2012.13.1.34
  8. Yamakado K, Nakatsuka A, Takaki H, Yokoi H, Usui M, Sakurai H, et al. Early-stage hepatocellular carcinoma: radiofrequency ablation combined with chemoembolization versus hepatectomy. Radiology 2008;247:260-266 https://doi.org/10.1148/radiol.2471070818
  9. Lee MW, Kim YJ, Park SW, Jeon HJ, Yi JG, Choe WH, et al. Percutaneous radiofrequency ablation of liver dome hepatocellular carcinoma invisible on ultrasonography: a new targeting strategy. Br J Radiol 2008;81:e130-e134 https://doi.org/10.1259/bjr/16397365
  10. Lee MW, Kim YJ, Park SW, Yu NC, Choe WH, Kwon SY, et al. Biplane fluoroscopy-guided radiofrequency ablation combined with chemoembolisation for hepatocellular carcinoma: initial experience. Br J Radiol 2011;84:691-697 https://doi.org/10.1259/bjr/27559204
  11. Bruix J, Sherman M; Practice Guidelines Committee, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma. Hepatology 2005;42:1208-1236 https://doi.org/10.1002/hep.20933
  12. Llovet JM, Di Bisceglie AM, Bruix J, Kramer BS, Lencioni R, Zhu AX, et al. Design and endpoints of clinical trials in hepatocellular carcinoma. J Natl Cancer Inst 2008;100:698-711 https://doi.org/10.1093/jnci/djn134
  13. Lencioni R, Llovet JM. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 2010;30:52-60 https://doi.org/10.1055/s-0030-1247132
  14. Rhim H, Choi D, Kim YS, Lim HK, Choe BK. Ultrasonography-guided percutaneous radiofrequency ablation of hepatocellular carcinomas: a feasibility scoring system for planning sonography. Eur J Radiol 2010;75:253-258 https://doi.org/10.1016/j.ejrad.2009.04.014
  15. Song I, Rhim H, Lim HK, Kim YS, Choi D. Percutaneous radiofrequency ablation of hepatocellular carcinoma abutting the diaphragm and gastrointestinal tracts with the use of artificial ascites: safety and technical efficacy in 143 patients. Eur Radiol 2009;19:2630-2640 https://doi.org/10.1007/s00330-009-1463-x
  16. Kim SW, Rhim H, Park M, Kim H, Kim YS, Choi D, et al. Percutaneous radiofrequency ablation of hepatocellular carcinomas adjacent to the gallbladder with internally cooled electrodes: assessment of safety and therapeutic efficacy. Korean J Radiol 2009;10:366-376 https://doi.org/10.3348/kjr.2009.10.4.366
  17. Chung YH. A strategy for early detection of recurrent hepatocellular carcinoma following initial remission by transcatheter arterial chemoembolization. Intervirology 2005;48:46-51 https://doi.org/10.1159/000082094
  18. Goldberg SN, Gazelle GS, Dawson SL, Rittman WJ, Mueller PR, Rosenthal DI. Tissue ablation with radiofrequency: effect of probe size, gauge, duration, and temperature on lesion volume. Acad Radiol 1995;2:399-404 https://doi.org/10.1016/S1076-6332(05)80342-3
  19. Morimoto M, Numata K, Kondou M, Nozaki A, Morita S, Tanaka K. Midterm outcomes in patients with intermediate-sized hepatocellular carcinoma: a randomized controlled trial for determining the efficacy of radiofrequency ablation combined with transcatheter arterial chemoembolization. Cancer 2010;116:5452-5460 https://doi.org/10.1002/cncr.25314
  20. Shibata T, Isoda H, Hirokawa Y, Arizono S, Shimada K, Togashi K. Small hepatocellular carcinoma: is radiofrequency ablation combined with transcatheter arterial chemoembolization more effective than radiofrequency ablation alone for treatment? Radiology 2009;252:905-913 https://doi.org/10.1148/radiol.2523081676
  21. Goldberg SN, Grassi CJ, Cardella JF, Charboneau JW, Dodd GD 3rd, Dupuy DE, et al. Image-guided tumor ablation: standardization of terminology and reporting criteria. J Vasc Interv Radiol 2009;20(7 Suppl):S377-S390 https://doi.org/10.1016/j.jvir.2009.04.011
  22. Goldberg SN, Grassi CJ, Cardella JF, Charboneau JW, Dodd GD 3rd, Dupuy DE, et al. Image-guided tumor ablation: standardization of terminology and reporting criteria. Radiology 2005;235:728-739 https://doi.org/10.1148/radiol.2353042205
  23. Yamakado K, Nakatsuka A, Ohmori S, Shiraki K, Nakano T, Ikoma J, et al. Radiofrequency ablation combined with chemoembolization in hepatocellular carcinoma: treatment response based on tumor size and morphology. J Vasc Interv Radiol 2002;13:1225-1232 https://doi.org/10.1016/S1051-0443(07)61969-1
  24. Miura H, Yamagami T, Terayama K, Yoshimatsu R, Matsumoto T, Nishimura T. Pneumothorax induced by radiofrequency ablation for hepatocellular carcinoma beneath the diaphragm under real-time computed tomography-fluoroscopic guidance. Acta Radiol 2010;51:613-618 https://doi.org/10.3109/02841851003786001
  25. Shibata T, Shibata T, Maetani Y, Kubo T, Itoh K, Togashi K, et al. Transthoracic percutaneous radiofrequency ablation for liver tumors in the hepatic dome. J Vasc Interv Radiol 2004;15:1323-1327 https://doi.org/10.1097/01.RVI.0000132297.97113.C4
  26. Toyoda M, Kakizaki S, Horiuchi K, Katakai K, Sohara N, Sato K, et al. Computed tomography-guided transpulmonary radiofrequency ablation for hepatocellular carcinoma located in hepatic dome. World J Gastroenterol 2006;12:608-611 https://doi.org/10.3748/wjg.v12.i4.608
  27. Kato T, Yamagami T, Hirota T, Matsumoto T, Yoshimatsu R, Nishimura T. Transpulmonary radiofrequency ablation for hepatocellular carcinoma under real-time computed tomography-fluoroscopic guidance. Hepatogastroenterology 2008;55:1450-1453
  28. Paulson EK, Sheafor DH, Enterline DS, McAdams HP, Yoshizumi TT. CT fluoroscopy--guided interventional procedures: techniques and radiation dose to radiologists. Radiology 2001;220:161-167 https://doi.org/10.1148/radiology.220.1.r01jl29161
  29. Min JH, Lee MW, Rhim H, Choi D, Kim YS, Kim YJ, et al. Recurrent hepatocellular carcinoma after transcatheter arterial chemoembolization: planning sonography for radio frequency ablation. J Ultrasound Med 2011;30:617-624 https://doi.org/10.7863/jum.2011.30.5.617

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