Treatment of hepatocellular carcinoma using internally cooled electrodes. A prospective comparison of modified automated vs. manual pulsed radiofrequency algorithms.
OBJECTIVE
To compare the effectiveness of modified automated and manual pulsed radiofrequency (RF) algorithms using internally cooled electrodes for hepatocellular carcinoma (HCC).


METHODS
Seventy-seven treatment-naive cirrhotic patients with 102 HCC (< or =4 cm) underwent 109 sessions of ultrasound-guided percutaneous RF ablation using a 17-gauge, 20-cm-long, single internally cooled electrode. Patients were assigned alternatively: 40 patients to the modified automated algorithm group and 37 patients to the manual algorithm group. The mean tumor diameters were 2.34 +/- 0.9 and 2.25 +/- 0.7 cm in the automated and manual groups, respectively (p = 0.56). Primary technique effectiveness and local tumor progression were compared between the two groups.


RESULTS
More overlapping ablations (n = 112) were required in the manual than in the automated group (n = 82) to achieve similar primary technique effectiveness rates of 96.1 and 94.1%, respectively. After a mean follow-up period of 26.7 +/- 1.1 months, the local tumor progression rates at 12 and 18 months were 4 and 20% in the manual group and 12 and 24% in the modified automated group (p = 0.3). Only tumors >3 cm were independently associated with local tumor progression (odds ratio 1.25; 95% CI 1.06-2.34, p = 0.03).


CONCLUSIONS
The manual algorithm requires more overlapping ablations and treatment sessions in order to achieve similar primary technique effectiveness and local tumor progression rates compared with the modified automated algorithm.
Cua
Ian Homer Y
IH
Liver Research Unit, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.
Lin
Chen-Chun
CC
Lin
Chun-Jung
CJ
Chen
Wei-Ting
WT
Hsu
Chao-Wei
CW
Chen
Yi-Cheng
YC
Wong
Stephen N
SN
Lin
Shi-Ming
SM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D016292:Procedural Sedation; D003287:Contrast Media; D018450:Disease Progression; D004566:Electrodes; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D053783:Magnetic Resonance Imaging, Interventional / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015641:Radiography, Interventional; D013696:Temperature; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D014463:Ultrasonography
D003287:Contrast Media