title: Scattered and rapid intrahepatic recurrences after radio frequency ablation for hepatocellular carcinoma.
abstract: OBJECTIVE
  To evaluate a series of patients with hepatocellular carcinoma (HCC) treated with several different protocols and devices.
  
  
  METHODS
  We treated 138 patients [chronic hepatitis/liver cirrhosis (Child-Pugh A/B/C), 3/135 (107/25/3)] with two different devices and protocols: cool-tip needle [initial ablation at 60 W (standard method) (n=37) or at 40 W (modified method) (n=28)] or; ablation with a LeVeen needle using a standard single-step, full expansion (single-step) method (n=39) or a multi-step, incremental expansion (multi-step) method.
  
  
  RESULTS
  Eleven patients experienced rapid and scattered recurrences 1 to 7 mo after the ablation. Nine patients were treated by the cool-tip original protocol (60 W) (9/37=24%) and the other two by the LeVeen single-step method (2/39=5%). The location of the recurrence was surrounding and limited to the site of ablation segment in three cases, and spread over one lobule or both lobules in the other eight cases. There was no recurrence in the patients treated with the modified cool-tip modified method (40 W) or the LeVeen multi-step method.
  
  
  CONCLUSIONS
  There is a risk of rapid and scattered recurrence after RFA, especially when the standard cool-tip procedure is used. Because such recurrence would worsen the prognosis, we recommend that modified protocols for the cool-tip and LeVeen needle methods should be used in clinical practice.
authors.affiliation: Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kotoh
authors.forename: Munechika
authors.initials: M
authors.lastname: Enjoji
authors.forename: Eiichirou
authors.initials: E
authors.lastname: Arimura
authors.forename: Shusuke
authors.initials: S
authors.lastname: Morizono
authors.forename: Motoyuki
authors.initials: M
authors.lastname: Kohjima
authors.forename: Hironori
authors.initials: H
authors.lastname: Sakai
authors.forename: Makoto
authors.initials: M
authors.lastname: Nakamuta
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000628:therapy; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011897:Random Allocation; D012008:Recurrence; D012189:Retrospective Studies