Percutaneous radiofrequency ablation of hepatic tumors during temporary venous occlusion.
OBJECTIVE
We evaluated the feasibility, tolerance, and efficacy of percutaneous hepatic vein or segmental portal branch balloon occlusion during radiofrequency ablation of hepatic malignancies.


METHODS
Ten tumors were treated by percutaneous radiofrequency ablation during balloon occlusion of a hepatic vein (n = 8) or a segmental portal branch (n = 2). Venous occlusion was undertaken because the tumor was in contact with a hepatic vein (n = 3) or a portal branch (n = 1); because the tumor exceeded 35 mm in width (mean, 44 mm), which was considered the maximum size amenable to ablation in a single session (n = 2); or because of both large size and contact with a hepatic vein (n = 3) or a portal branch (n = 1).


RESULTS
Vascular occlusion was always technically possible. Radiofrequency was delivered to one to three locations (mean, 1.9 locations) with a cluster electrode. The largest axis of radiofrequency-induced lesions after ablation with the cluster needle-between 42 and 51 mm (mean, 49 mm)-was always larger than the targeted tumor. These sizes were statistically larger than in a matched control group of patients who underwent radiofrequency ablation without vascular occlusion (p < 0.0003). After a mean follow-up of 12.6 months, CT and MR imaging revealed complete destruction of nine tumors after a single radiofrequency ablation treatment; one tumor required three treatments to achieve ablation. Five patients are tumor-free 12-18 months (mean, 14.4 months) after the first radiofrequency ablation treatment, and five developed new liver metastases.


CONCLUSIONS
Temporary hepatic vein or portal branch occlusion during radiofrequency ablation can safely facilitate the treatment of large tumors or tumors in contact with the walls of large vessels.
de Baere
T
T
Département d'Imagerie Médicale, Service de Radiologie Interventionnelle, Institut Gustave Roussy, 94805 Villejuif Cedex, France.
Bessoud
B
B
Dromain
C
C
Ducreux
M
M
Boige
V
V
Lassau
N
N
Smayra
T
T
Girish
B V
BV
Roche
A
A
Elias
D
D
D000328:Adult; D000368:Aged; D021721:Balloon Occlusion; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000175:diagnosis / Q000628:therapy*; D015179:Colorectal Neoplasms / Q000098:blood supply / Q000175:diagnosis / Q000556:secondary / Q000628:therapy; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006503:Hepatic Veins; D006801:Humans; D006979:Hyperthermia, Induced; D008113:Liver Neoplasms / Q000098:blood supply / Q000175:diagnosis / Q000556:secondary / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D016896:Treatment Outcome