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Vascular and Interventional Radiology |
1 From the Depts of Gastroenterology (S.R.), Emergency Medicine (F.F.), and Radiology (P.Q.), Public Hospital of Piacenza, Italy; Depts of Radiology (F.G., A.M., G.D.T., C.A.) and Surgery (V.M.), National Cancer Institute, via Venezian 1, 20133 Milan, Italy; Dept of Radiology, Univ of Pisa, Italy (R.L., C.B.); and Dept of Gastroenterology, Univ of Freiburg, Germany (H.P.A., H.E.B.). Received Aug 23, 1999; revision requested Oct 7; revision received Jan 4, 2000; accepted Feb 7. Address correspondence to F.G. (e-mail: garbagnatif@yahoo.com).
PURPOSE: To evaluate the usefulness of percutaneous radio-frequency (RF) thermal ablation of nonresectable hepatocellular carcinoma (HCC) after occlusion of the tumor arterial supply.
MATERIALS AND METHODS: Sixty-two patients with cirrhosis and biopsy-proved HCC underwent RF ablation after interruption of the tumor arterial supply by means of occlusion of either the hepatic artery with a balloon catheter (40 patients) or the feeding arteries with gelatin sponge particles (22 patients).
RESULTS: After a single RF procedure in 56 patients and after two procedures in six patients, spiral computed tomography (CT) demonstrated a nonenhancing area corresponding in shape to the previously identified HCC, which was suggestive of complete necrosis. No major complications occurred. Two patients subsequently underwent surgical resection; the remaining 60 patients were followed up with spiral CT. During a mean follow-up of 12.1 months, 11 HCC nodules showed areas of local progression; 49 were identified as nonenhancing areas with a 40%–75% reduction in maximum diameter. The 1-year estimate of failure risk was 19% for local recurrence and 45% for overall intrahepatic recurrence. The estimated 1-year survival was 87%. Histopathologic analysis of one autopsy and two surgical specimens revealed more than 90% necrosis in one specimen and 100% necrosis in two.
CONCLUSION: HCC nodules 3.5–8.5 cm in diameter can be ablated in one or two RF sessions after occlusion of the tumor arterial supply.
Index terms: Liver, interventional procedures, 761.1264, 761.1269 • Liver neoplasms, 761.323 • Liver neoplasms, angiography, 761.1242 • Liver neoplasms, CT, 761.12112, 761.12114, 761.12115 • Liver neoplasms, MR, 761.121411, 761.121412, 761.12143 • Radiofrequency (RF) ablation, 761.1269
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