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Large (5.0-cm) HCCs: Multipolar RF Ablation with Three Internally Cooled Bipolar Electrodes—Initial Experience in 26 Patients¹

¹ From the Departments of Radiology (O.S., M.I., Y.A., C.B., E.C., N.S.) and Hepatogastroenterology (G.N., N.G., J.C.T., M.B.), Centre Hôspitalo-Universitaire Jean Verdier, Assistance Publique-Hôpitaux de Paris, avenue du 14 Juillet, 93140 Bondy, France; and UPRES EA 3409, Unité d'Enseignement et de Recherche, Santé Médecine et Biologie Humaine, Université Paris XIII, Paris, France (O.S., G.N., N.G., J.C.T.). From the 2006 RSNA Annual Meeting. Received June 22, 2007; revision requested August 27; revision received October 11; accepted January 8, 2008; final version accepted January 10. Address correspondence to O.S. (e-mail: olivier.seror{at}jvr.aphp.fr).

Purpose: To prospectively evaluate the safety and effectiveness of percutaneous multipolar radiofrequency (RF) ablation for the treatment of large (5.0 cm in diameter) hepatocellular carcinomas (HCCs).

Materials and Methods: Twenty-six patients (four women, 22 men; median age, 72 years) with cirrhosis (Child-Pugh class A disease, 22 patients; Child-Pugh class B disease, four patients) and at least one 5.0–9.0-cm-diameter HCC without invasion of the portal trunk or main portal branches were treated with multipolar RF ablation performed by a single operator. The procedure was performed with three separate bipolar linear internally cooled electrodes with ultrasonographic guidance. Twenty-seven of the 33 tumors treated had a diameter of 5.0 cm or greater (median diameter, 5.7 cm; range, 5.0–8.5 cm); 12 of these 27 tumors were infiltrative, and four invaded segmental portal vein branches. Ten patients had a serum -fetoprotein level higher than 400 µg/L. Results were assessed by using computed tomography. Primary effectiveness, complications, tumor progression, and survival rates were recorded. Probabilities of survival were calculated by using the Kaplan-Meier method.

Results: One to two RF ablation procedures per patient (mean, 1.15 ± 0.43 [standard deviation]) led to the complete ablation of 22 (81%) of the 27 tumors (18 tumors after one and four tumors after two procedures), including three tumors that showed segmental portal vein invasion. All patients experienced postablation syndrome, and one experienced subcapsular hematoma and a segmental liver infarct, but no major complication occurred. After a mean follow-up of 14 months (range, 3–34 months), local and distant tumor progression and actual survival rates were 14% (three of 22), 24% (five of 21), and 65% (17 of 26), respectively. The probabilities of 1- and 2-year survival, respectively, were 68% (95% confidence interval: 49%, 86%) and 56% (95% confidence interval: 51%, 81%).

Conclusion: HCCs larger than 5.0 cm (but smaller than 9.0 cm)—even those that are infiltrative and those that involve a segmental portal vein—can be completely and safely ablated with multipolar RF ablation.

© RSNA, 2008

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