Korean Journal of Radiology

  • 제24권8호
  • /
  • Pages.719-728
  • /
  • 2023
  • /
  • 1229-6929(pISSN)
  • /
  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지
DOI QR코드

DOI QR Code

No-Touch Radiofrequency Ablation for Early Hepatocellular Carcinoma: 2023 Korean Society of Image-Guided Tumor Ablation Guidelines

  • Seungchul Han (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Min Woo Lee (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Young Joon Lee (Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Hyun Pyo Hong (Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Dong Ho Lee (Department of Radiology, Seoul National University Hospital) ;
  • Jeong Min Lee (Department of Radiology, Seoul National University Hospital)
  • 투고 : 2023.05.07
  • 심사 : 2023.05.09
  • 발행 : 2023.08.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Radiofrequency ablation (RFA) has been widely used to manage hepatocellular carcinomas (HCCs) equal to or smaller than 3 cm. No-touch RFA has gained attention and has recently been implemented in local ablation therapy for HCCs, despite its technical complexity, as it provides improved local tumor control compared to conventional tumor-puncturing RFA. This article presents the practice guidelines for performing no-touch RFA for HCCs, which have been endorsed by the Korean Society of Image-Guided Tumor Ablation (KSITA). The guidelines are primarily designed to assist interventional oncologists and address the limitations of conventional tumor-puncturing RFA with describing the fundamental principles, various energy delivery methods, and clinical outcomes of no-touch RFA. The clinical outcomes include technical feasibility, local tumor progression rates, survival outcomes, and potential complications.

키워드

과제정보

This work was supported by the Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety) (Project Number: RS2020-KD000303, 1711138983).

참고문헌

  1. Omata M, Cheng AL, Kokudo N, Kudo M, Lee JM, Jia J, et al. Asia-Pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update. Hepatol Int 2017;11:317-370 https://doi.org/10.1007/s12072-017-9799-9
  2. European Association for the Study of the Liver. EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 2018;69:182-236 https://doi.org/10.1016/j.jhep.2018.03.019
  3. Heimbach JK, Kulik LM, Finn RS, Sirlin CB, Abecassis MM, Roberts LR, et al. AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology 2018;67:358-380 https://doi.org/10.1002/hep.29086
  4. Korean Liver Cancer Association (KLCA) and National Cancer Center (NCC) Korea. 2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma. Korean J Radiol 2022;23:1126-1240 https://doi.org/10.3348/kjr.2022.0822
  5. Korean Liver Cancer Association KLC, National Cancer Center (NCC), Goyang, Korea. 2018 Korean Liver Cancer AssociationNational Cancer Center Korea practice guidelines for the management of hepatocellular carcinoma. Korean J Radiol 2019;20:1042-1113 https://doi.org/10.3348/kjr.2019.0140
  6. Schunemann HJ, Oxman AD, Brozek J, Glasziou P, Jaeschke R, Vist GE, et al. Grading quality of evidence and strength of recommendations for diagnostic tests and strategies. BMJ 2008;336:1106-1110 https://doi.org/10.1136/bmj.39500.677199.AE
  7. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, AlonsoCoello P, et al. Grade: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336:924-926 https://doi.org/10.1136/bmj.39489.470347.AD
  8. Guyatt GH, Oxman AD, Kunz R, Vist GE, Falck-Ytter Y, Schunemann HJ, et al. What is "quality of evidence" and why is it important to clinicians? BMJ 2008;336:995-998 https://doi.org/10.1136/bmj.39490.551019.BE
  9. Guyatt GH, Oxman AD, Kunz R, Falck-Ytter Y, Vist GE, Liberati A, et al. Going from evidence to recommendations. BMJ 2008;336:1049-1051 https://doi.org/10.1136/bmj.39493.646875.AE
  10. Kim YS, Lim HK, Rhim H, Lee MW, Choi D, Lee WJ, et al. Tenyear outcomes of percutaneous radiofrequency ablation as first-line therapy of early hepatocellular carcinoma: analysis of prognostic factors. J Hepatol 2013;58:89-97 https://doi.org/10.1016/j.jhep.2012.09.020
  11. Jaskolka JD, Asch MR, Kachura JR, Ho CS, Ossip M, Wong F, et al. Needle tract seeding after radiofrequency ablation of hepatic tumors. J Vasc Interv Radiol 2005;16:485-491 https://doi.org/10.1097/01.RVI.0000151141.09597.5F
  12. Angonese C, Baldan A, Cillo U, D'Alessandro A, De Antoni M, De Giorgio M, et al. Complications of radiofrequency thermal ablation in hepatocellular carcinoma: what about "explosive" spread? Gut 2006;55:435-436 https://doi.org/10.1136/gut.2005.080515
  13. 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
  14. Cha J, Choi D, Lee MW, Rhim H, Kim YS, Lim HK, et al. Radiofrequency ablation zones in ex vivo bovine and in vivo porcine livers: comparison of the use of internally cooled electrodes and internally cooled wet electrodes. Cardiovascular Intervent Radiol 2009;32:1235-1240 https://doi.org/10.1007/s00270-009-9600-0
  15. 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
  16. Lee DH, Lee MW, Kim PN, Lee YJ, Park HS, Lee JM. Outcome of no-touch radiofrequency ablation for small hepatocellular carcinoma: a multicenter clinical trial. Radiology 2021;301:229-236 https://doi.org/10.1148/radiol.2021210309
  17. Seror O, N'Kontchou G, Nault JC, Rabahi Y, Nahon P, GanneCarrie N, et al. Hepatocellular carcinoma within milan criteria: no-touch multibipolar radiofrequency ablation for treatmentlong-term results. Radiology 2016;280:611-621 https://doi.org/10.1148/radiol.2016150743
  18. Seror O, N'Kontchou G, Van Nhieu JT, Rabahi Y, Nahon P, Laurent A, et al. Histopathologic comparison of monopolar versus no-touch multipolar radiofrequency ablation to treat hepatocellular carcinoma within milan criteria. J Vasc Interv Radiol 2014;25:599-607 https://doi.org/10.1016/j.jvir.2013.11.025
  19. Kim TH, Lee JM, Lee DH, Joo I, Park SJ, Yoon JH. Can "notouch" radiofrequency ablation for hepatocellular carcinoma improve local tumor control? Systematic review and metaanalysis. Eur Radiol 2023;33:545-554 https://doi.org/10.1007/s00330-022-08991-1
  20. Hocquelet A, Aube C, Rode A, Cartier V, Sutter O, Manichon AF, et al. Comparison of no-touch multi-bipolar vs. monopolar radiofrequency ablation for small hcc. J Hepatol 2017;66:67-74 https://doi.org/10.1016/j.jhep.2016.07.010
  21. Lee HJ, Lee MW, Ahn SH, Cha DI, Ko SE, Kang TW, et al. Percutaneous radiofrequency ablation of solitary hepatic metastases from colorectal cancer: risk factors of local tumor progression-free survival and overall survival. Ultrasonography 2022;41:728-739 https://doi.org/10.14366/usg.21256
  22. Petit A, Hocquelet A, N'kontchou G, Varin E, Sellier N, Seror O, et al. No-touch multi-bipolar radiofrequency ablation for the treatment of subcapsular hepatocellular carcinoma ≤ 5 cm not puncturable via the non-tumorous liver parenchyma. Cardiovasc Intervent Radiol 2020;43:273-283 https://doi.org/10.1007/s00270-019-02357-9
  23. Qu C, Li XQ, Li C, Xia F, Feng K, Ma K. The short-term efficacy of novel no-touch combined directional perfusion radiofrequency ablation in the treatment of small hepatocellular carcinoma with cirrhosis. J Invest Surg 2022;35:880-887 https://doi.org/10.1080/08941939.2021.1931575
  24. Chai Y, Li K, Zhang C, Chen S, Ma K. The short-term efficacy of no-touch radiofrequency ablation in treating cirrhosis-based small hepatocellular carcinoma. BMC Cancer 2019;19:497
  25. Kawamura Y, Ikeda K, Fujiyama S, Hosaka T, Kobayashi M, Saitoh S, et al. Potential of a no-touch pincer ablation procedure that uses a multipolar radiofrequency ablation system to prevent intrasubsegmental recurrence of small and single hepatocellular carcinomas. Hepatol Res 2017;47:1008-1020 https://doi.org/10.1111/hepr.12838
  26. Mohkam K, Dumont PN, Manichon AF, Jouvet JC, Boussel L, Merle P, et al. No-touch multibipolar radiofrequency ablation vs. surgical resection for solitary hepatocellular carcinoma ranging from 2 to 5cm. J Hepatol 2018;68:1172-1180 https://doi.org/10.1016/j.jhep.2018.01.014
  27. Wu LW, Chen CY, Liu CJ, Chen MY, Liu PC, Liu PF, et al. Multipolar radiofrequency ablation with non-touch technique for hepatocellular carcinoma≤ 3 cm: a preliminary report. Adv Dig Med 2014;1:80-85
  28. Hirooka M, Hiraoka A, Ochi H, Koizumi Y, Michitaka K, Joko K, et al. Prospective cohort trial to confirm the efficacy of no-touch radio frequency ablation. J Gastroenterol Hepatol 2019;34:567-574 https://doi.org/10.1111/jgh.14476
  29. Park SJ, Cho EJ, Lee JH, Yu SJ, Kim YJ, Yoon JH, et al. Switching monopolar no-touch radiofrequency ablation using octopus electrodes for small hepatocellular carcinoma: a randomized clinical trial. Liver Cancer 2021;10:72-81 https://doi.org/10.1159/000512338
  30. Suh YS, Choi JW, Yoon JH, Lee DH, Kim YJ, Lee JH, et al. Notouch vs. conventional radiofrequency ablation using twin internally cooled wet electrodes for small hepatocellular carcinomas: a randomized prospective comparative study. Korean J Radiol 2021;22:1974-1984 https://doi.org/10.3348/kjr.2021.0319
  31. Tateishi R, Shiina S, Akahane M, Sato J, Kondo Y, Masuzaki R, et al. Frequency, risk factors and survival associated with an intrasubsegmental recurrence after radiofrequency ablation for hepatocellular carcinoma. PLoS One 2013;8:e59040
  32. Cha DI, Lee MW, Song KD, Ko SE, Rhim H. Ablative outcomes of various energy modes for no-touch and peripheral tumorpuncturing radiofrequency ablation: an ex vivo simulation study. Korean J Radiol 2022;23:189-201 https://doi.org/10.3348/kjr.2021.0451
  33. Seror O. No touch radiofrequency ablation for hepatocellular carcinoma: a conceptual approach rather than an iron law. Hepatobiliary Surg Nutr 2022;11:132-135 https://doi.org/10.21037/hbsn-21-512
  34. Seror O, Sutter O. Re: should we use a monopolar or bipolar mode for performing no-touch radiofrequency ablation of liver tumors? Clinical practice might have already resolved the matter once and for all. Korean J Radiol 2017;18:749-752 https://doi.org/10.3348/kjr.2017.18.4.749
  35. Chang W, Lee JM, Lee SM, Han JK. No-touch radiofrequency ablation: a comparison of switching bipolar and switching monopolar ablation in ex vivo bovine liver. Korean J Radiol 2017;18:279-288 https://doi.org/10.3348/kjr.2017.18.2.279
  36. Chang W, Lee JM, Yoon JH, Lee DH, Lee SM, Lee KB, et al. No-touch radiofrequency ablation using multiple electrodes: an in vivo comparison study of switching monopolar versus switching bipolar modes in porcine livers. PLoS One 2017;12:e0176350
  37. 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
  38. Lee MW, Lim HK, Kim YJ, Choi D, Kim YS, Lee WJ, et al. Percutaneous sonographically guided radio frequency ablation of hepatocellular carcinoma: causes of mistargeting and factors affecting the feasibility of a second ablation session. J Ultrasound Med 2011;30:607-615 https://doi.org/10.7863/jum.2011.30.5.607
  39. Crocetti L, Lencioni R, Debeni S, See TC, Pina CD, Bartolozzi C. Targeting liver lesions for radiofrequency ablation: an experimental feasibility study using a CT-us fusion imaging system. Invest Radiol 2008;43:33-39 https://doi.org/10.1097/RLI.0b013e31815597dc
  40. 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
  41. Minami Y, Kudo M. Ultrasound fusion imaging of hepatocellular carcinoma: a review of current evidence. Dig Dis 2014;32:690-695 https://doi.org/10.1159/000368001
  42. Song KD, Lee MW, Rhim H, Cha DI, Chong Y, Lim HK. Fusion imaging-guided radiofrequency ablation for hepatocellular carcinomas not visible on conventional ultrasound. AJR Am J Roentgenol 2013;201:1141-1147 https://doi.org/10.2214/AJR.13.10532
  43. Lee DH, Lee JM. Recent advances in the image-guided tumor ablation of liver malignancies: radiofrequency ablation with multiple electrodes, real-time multimodality fusion imaging, and new energy sources. Korean J Radiol 2018;19:545-559 https://doi.org/10.3348/kjr.2018.19.4.545
  44. Han S, Lee JM, Lee DH, Yoon JH, Chang W. Utility of realtime CT/MRI-US automatic fusion system based on vascular matching in percutaneous radiofrequency ablation for hepatocellular carcinomas: a prospective study. Cardiovasc Intervent Radiol 2021;44:1579-1596
  45. Lee MW. Fusion imaging of real-time ultrasonography with CT or MRI for hepatic intervention. Ultrasonography 2014;33:227-239 https://doi.org/10.14366/usg.14021
  46. Ahn SJ, Lee JM, Lee DH, Lee SM, Yoon JH, Kim YJ, et al. Real-time US-CT/MR fusion imaging for percutaneous radiofrequency ablation of hepatocellular carcinoma. J Hepatol 2017;66:347-354 https://doi.org/10.1016/j.jhep.2016.09.003
  47. Huang DY, Yusuf GT, Daneshi M, Ramnarine R, Deganello A, Sellars ME, et al. Contrast-enhanced ultrasound (CEUS) in abdominal intervention. Abdom Radiol (NY) 2018;43:960-976 https://doi.org/10.1007/s00261-018-1473-8
  48. Lee MW, Lim HK, Rhim H, Cha DI, Kang TW, Song KD, et al. Percutaneous radiofrequency ablation of small (1-2cm) hepatocellular carcinomas inconspicuous on B-mode ultrasonographic imaging: usefulness of combined fusion imaging with MRI and contrast-enhanced ultrasonography. Can J Gastroenterol Hepatol 2018;2018:7926923
  49. Minami T, Minami Y, Chishina H, Arizumi T, Takita M, Kitai S, et al. Combination guidance of contrast-enhanced US and fusion imaging in radiofrequency ablation for hepatocellular carcinoma with poor conspicuity on contrast-enhanced US/fusion imaging. Oncology 2014;87 Suppl 1:55-62 https://doi.org/10.1159/000368146
  50. Minami Y, Kudo M. Image guidance in ablation for hepatocellular carcinoma: contrast-enhanced ultrasound and fusion imaging. Front Oncol 2021;11:593636
  51. Minami Y, Kudo M, Hatanaka K, Kitai S, Inoue T, Hagiwara S, et al. Radiofrequency ablation guided by contrast harmonic sonography using perfluorocarbon microbubbles (Sonazoid) for hepatic malignancies: an initial experience. Liver Int 2010;30:759-764 https://doi.org/10.1111/j.1478-3231.2010.02226.x
  52. Sparchez Z, Mocan T, Craciun R, Sparchez M, Nolsoe C. Contrast enhancement for ultrasound-guided interventions: when to use it and what to expect? Ultrasonography 2022;41:263-278 https://doi.org/10.14366/usg.21207
  53. Hsieh YC, Limquiaco JL, Lin CC, Chen WT, Lin SM. Radiofrequency ablation following artificial ascites and pleural effusion creation may improve outcomes for hepatocellular carcinoma in high-risk locations. Abdom Radiol (NY) 2019;44:1141-1151 https://doi.org/10.1007/s00261-018-1831-6
  54. 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
  55. Kim JW, Shin SS, Heo SH, Hong JH, Lim HS, Seon HJ, et al. Ultrasound-guided percutaneous radiofrequency ablation of liver tumors: how we do it safely and completely. Korean J Radiol 2015;16:1226-1239 https://doi.org/10.3348/kjr.2015.16.6.1226
  56. Kondo Y, Yoshida H, Shiina S, Tateishi R, Teratani T, Omata M. Artificial ascites technique for percutaneous radiofrequency ablation of liver cancer adjacent to the gastrointestinal tract. Br J Surg 2006;93:1277-1282 https://doi.org/10.1002/bjs.5374
  57. Park SJ, Lee DH, Han JK. Reducing pain by artificial ascites infusion during radiofrequency ablation for subcapsular hepatocellular carcinoma. Cardiovasc Intervent Radiol 2021;44:565-573  https://doi.org/10.1007/s00270-020-02723-y