Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Computed Tomographic-Guided Radiofrequency Ablation of Recurrent or Residual Hepatocellular Carcinomas around Retained Iodized Oil after Transarterial Chemoembolization

  • Koh, Young Hwan (Center for Liver Cancer, National Cancer Center) ;
  • Choi, Joon-Il (Center for Liver Cancer, National Cancer Center) ;
  • Kim, Hyun Beom (Center for Liver Cancer, National Cancer Center) ;
  • Kim, Min Ju (Department of Radiology, Research Institute and Hospital, National Cancer Center)
  • Received : 2012.11.19
  • Accepted : 2013.04.18
  • Published : 2013.09.01
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Abstract

Objective: To 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 Methods: Sixty-four patients (M : F = 51 : 13, 65.0 ${\pm}$ 8.2 years old) with recurrent or residual HCC (75 index tumors, size = 14.0 ${\pm}$ 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. Results: The 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. Conclusion: CT-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.

Keywords

References

  1. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin 2005;55:74-108 https://doi.org/10.3322/canjclin.55.2.74
  2. Bruix J, Sherman M; American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology 2011;53:1020-1022 https://doi.org/10.1002/hep.24199
  3. Chen MS, Li JQ, Zheng Y, Guo RP, Liang HH, Zhang YQ, et al. A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg 2006;243:321-328 https://doi.org/10.1097/01.sla.0000201480.65519.b8
  4. Cho YK, Kim JK, Kim WT, Chung JW. Hepatic resection versus radiofrequency ablation for very early stage hepatocellular carcinoma: a Markov model analysis. Hepatology 2010;51:1284-1290 https://doi.org/10.1002/hep.23466
  5. Livraghi T, Meloni F, Di Stasi M, Rolle E, Solbiati L, Tinelli C, et al. Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: is resection still the treatment of choice? Hepatology 2008;47:82-89
  6. Lee MW, Kim YJ, Park HS, Yu NC, Jung SI, Ko SY, et al. Targeted sonography for small hepatocellular carcinoma discovered by CT or MRI: factors affecting sonographic detection. AJR Am J Roentgenol 2010;194:W396-W400 https://doi.org/10.2214/AJR.09.3171
  7. 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
  8. Kim YK, Kim CS, Lee JM, Chung GH, Chon SB. Efficacy and safety of radiofrequency ablation of hepatocellular carcinoma in the hepatic dome with the CT-guided extrathoracic transhepatic approach. Eur J Radiol 2006;60:100-107 https://doi.org/10.1016/j.ejrad.2006.05.002
  9. Laspas F, Sotiropoulou E, Mylona S, Manataki A, Tsagouli P, Tsangaridou I, et al. Computed tomography-guided radiofrequency ablation of hepatocellular carcinoma: treatment efficacy and complications. J Gastrointestin Liver Dis 2009;18:323-328
  10. Park BJ, Byun JH, Jin YH, Won HJ, Shin YM, Kim KW, et al. CT-guided radiofrequency ablation for hepatocellular carcinomas that were undetectable at US: therapeutic effectiveness and safety. J Vasc Interv Radiol 2009;20:490-499 https://doi.org/10.1016/j.jvir.2009.01.004
  11. 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
  12. Laganà D, Carrafiello G, Mangini M, Lumia D, Mocciardini L, Chini C, et al. Hepatic radiofrequency under CT-fluoroscopy guidance. Radiol Med 2008;113:87-100 https://doi.org/10.1007/s11547-008-0224-2
  13. Takaki H, Yamakado K, Uraki J, Nakatsuka A, Fuke H, Yamamoto N, et al. Radiofrequency ablation combined with chemoembolization for the treatment of hepatocellular carcinomas larger than 5 cm. J Vasc Interv Radiol 2009;20:217-224 https://doi.org/10.1016/j.jvir.2008.10.019
  14. Veltri A, Moretto P, Doriguzzi A, Pagano E, Carrara G, Gandini G. Radiofrequency thermal ablation (RFA) after transarterial chemoembolization (TACE) as a combined therapy for unresectable non-early hepatocellular carcinoma (HCC). Eur Radiol 2006;16:661-669 https://doi.org/10.1007/s00330-005-0029-9
  15. 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
  16. 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
  17. Kim YS, Lee WJ, Rhim H, Lim HK, Choi D, Lee JY. The minimal ablative margin of radiofrequency ablation of hepatocellular carcinoma (> 2 and < 5 cm) needed to prevent local tumor progression: 3D quantitative assessment using CT image fusion. AJR Am J Roentgenol 2010;195:758-765 https://doi.org/10.2214/AJR.09.2954
  18. Liu CH, Arellano RS, Uppot RN, Samir AE, Gervais DA, Mueller PR. Radiofrequency ablation of hepatic tumours: effect of post-ablation margin on local tumour progression. Eur Radiol 2010;20:877-885 https://doi.org/10.1007/s00330-009-1610-4
  19. Nakazawa T, Kokubu S, Shibuya A, Ono K, Watanabe M, Hidaka H, et al. Radiofrequency ablation of hepatocellular carcinoma: correlation between local tumor progression after ablation and ablative margin. AJR Am J Roentgenol 2007;188:480-488 https://doi.org/10.2214/AJR.05.2079
  20. Burke DR, Lewis CA, Cardella JF, Citron SJ, Drooz AT, Haskal ZJ, et al. Quality improvement guidelines for percutaneous transhepatic cholangiography and biliary drainage. Society of Cardiovascular and Interventional Radiology. J Vasc Interv Radiol 1997;8:677-681 https://doi.org/10.1016/S1051-0443(97)70630-4
  21. Chang NK, Shin SS, Kim JW, Kim HJ, Jeong YY, Heo SH, et al. Effect of ultrasound-guided radiofrequency ablation in incompletely treated hepatocellular carcinoma after transcatheter arterial chemoembolization. Korean J Radiol 2012;13 Suppl 1:S104-S111 https://doi.org/10.3348/kjr.2012.13.S1.S104
  22. Rhim H, Lee MH, Kim YS, Choi D, Lee WJ, Lim HK. Planning sonography to assess the feasibility of percutaneous radiofrequency ablation of hepatocellular carcinomas. AJR Am J Roentgenol 2008;190:1324-1330 https://doi.org/10.2214/AJR.07.2970
  23. Miyamoto N, Hiramatsu K, Tsuchiya K, Sato Y, Terae S, Shirato H. Sonazoid-enhanced sonography for guiding radiofrequency ablation for hepatocellular carcinoma: better tumor visualization by Kupffer-phase imaging and vascular-phase imaging after reinjection. Jpn J Radiol 2009;27:185-193 https://doi.org/10.1007/s11604-009-0317-4
  24. Rhim H, Lim HK, Kim YS, Choi D. Percutaneous radiofrequency ablation with artificial ascites for hepatocellular carcinoma in the hepatic dome: initial experience. AJR Am J Roentgenol 2008;190:91-98 https://doi.org/10.2214/AJR.07.2384
  25. Lee MW, Rhim H, Cha DI, Kim YJ, Choi D, Kim YS, et al. Percutaneous radiofrequency ablation of hepatocellular carcinoma: fusion imaging guidance for management of lesions with poor conspicuity at conventional sonography. AJR Am J Roentgenol 2012;198:1438-1444 https://doi.org/10.2214/AJR.11.7568
  26. Minami Y, Chung H, Kudo M, Kitai S, Takahashi S, Inoue T, et al. Radiofrequency ablation of hepatocellular carcinoma: value of virtual CT sonography with magnetic navigation. AJR Am J Roentgenol 2008;190:W335-W341 https://doi.org/10.2214/AJR.07.3092
  27. Kang TW, Rhim H, Kim EY, Kim YS, Choi D, Lee WJ, et al. Percutaneous radiofrequency ablation for the hepatocellular carcinoma abutting the diaphragm: assessment of safety and therapeutic efficacy. Korean J Radiol 2009;10:34-42 https://doi.org/10.3348/kjr.2009.10.1.34
  28. Cho YK, Rhim H, Noh S. Radiofrequency ablation versus surgical resection as primary treatment of hepatocellular carcinoma meeting the Milan criteria: a systematic review. J Gastroenterol Hepatol 2011;26:1354-1360
  29. Lam VW, Ng KK, Chok KS, Cheung TT, Yuen J, Tung H, et al. Risk factors and prognostic factors of local recurrence after radiofrequency ablation of hepatocellular carcinoma. J Am Coll Surg 2008;207:20-29 https://doi.org/10.1016/j.jamcollsurg.2008.01.020
  30. Lu DS, Raman SS, Limanond P, Aziz D, Economou J, Busuttil R, et al. Influence of large peritumoral vessels on outcome of radiofrequency ablation of liver tumors. J Vasc Interv Radiol 2003;14:1267-1274 https://doi.org/10.1097/01.RVI.0000092666.72261.6B
  31. Park Y, Kim YS, Rhim H, Lim HK, Choi D, Lee WJ. Arterial enhancement of hepatocellular carcinoma before radiofrequency ablation as a predictor of postablation local tumor progression. AJR Am J Roentgenol 2009;193:757-763 https://doi.org/10.2214/AJR.08.2202
  32. Waki K, Aikata H, Katamura Y, Kawaoka T, Takaki S, Hiramatsu A, et al. Percutaneous radiofrequency ablation as first-line treatment for small hepatocellular carcinoma: results and prognostic factors on long-term follow up. J Gastroenterol Hepatol 2010;25:597-604 https://doi.org/10.1111/j.1440-1746.2009.06125.x
  33. Golfieri R, Cappelli A, Cucchetti A, Piscaglia F, Carpenzano M, Peri E, et al. Efficacy of selective transarterial chemoembolization in inducing tumor necrosis in small (<5cm) hepatocellular carcinomas. Hepatology 2011;53:1580-1589 https://doi.org/10.1002/hep.24246
  34. Kim SJ, Choi MS, Kang JY, Choi DI, Park CK, Gwak GY, et al. Prediction of complete necrosis of hepatocellular carcinoma treated with transarterial chemoembolization prior to liver transplantation. Gut Liver 2009;3:285-291 https://doi.org/10.5009/gnl.2009.3.4.285
  35. Min JH, Lee MW, Rhim H, Choi D, Kim YS, Kim YJ, et al. Radiofrequency ablation for viable hepatocellular carcinoma around retained iodized oil after transcatheter arterial chemoembolization: usefulness of biplane fluoroscopy plus ultrasound guidance. Korean J Radiol 2012;13:784-794 https://doi.org/10.3348/kjr.2012.13.6.784

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