Percutaneous radio-frequency thermal ablation of nonresectable hepatocellular carcinoma after occlusion of tumor blood supply.
OBJECTIVE
To evaluate the usefulness of percutaneous radio-frequency (RF) thermal ablation of nonresectable hepatocellular carcinoma (HCC) after occlusion of the tumor arterial supply.


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.


CONCLUSIONS
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.
Rossi
S
S
Depts of Gastroenterology, Emergency Medicine, and Radiology, Public Hospital of Piacenza, Italy.
Garbagnati
F
F
Lencioni
R
R
Allgaier
H P
HP
Marchianò
A
A
Fornari
F
F
Quaretti
P
P
Tolla
G D
GD
Ambrosi
C
C
Mazzaferro
V
V
Blum
H E
HE
Bartolozzi
C
C
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000601:surgery*; D002404:Catheterization; D003287:Contrast Media; D004564:Electrocoagulation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D019786:Gadolinium DTPA; D005781:Gelatin Sponge, Absorbable; D006801:Humans; D008099:Liver / Q000098:blood supply*; D008113:Liver Neoplasms / Q000098:blood supply / Q000601:surgery*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D003287:Contrast Media; D019786:Gadolinium DTPA