title: Large (>or=5.0-cm) HCCs: multipolar RF ablation with three internally cooled bipolar electrodes--initial experience in 26 patients.
abstract: OBJECTIVE
  To prospectively evaluate the safety and effectiveness of percutaneous multipolar radiofrequency (RF) ablation for the treatment of large (>or=5.0 cm in diameter) hepatocellular carcinomas (HCCs).
  
  
  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 alpha-fetoprotein level higher than 400 microg/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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiology, Centre Hôspitalo-Universitaire Jean Verdier, Assistance Publique-Hôpitaux de Paris, avenue du 14 Juillet, 93140 Bondy, France. olivier.seror@jvr.aphp.fr
authors.forename: Olivier
authors.initials: O
authors.lastname: Seror
authors.forename: Gisèle
authors.initials: G
authors.lastname: N'Kontchou
authors.forename: Medhat
authors.initials: M
authors.lastname: Ibraheem
authors.forename: Yves
authors.initials: Y
authors.lastname: Ajavon
authors.forename: Corinne
authors.initials: C
authors.lastname: Barrucand
authors.forename: Nathalie
authors.initials: N
authors.lastname: Ganne
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Coderc
authors.forename: Jean Claude
authors.initials: JC
authors.lastname: Trinchet
authors.forename: Michel
authors.initials: M
authors.lastname: Beaugrand
authors.forename: Nicolas
authors.initials: N
authors.lastname: Sellier
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation* / Q000379:methods; D003080:Cold Temperature; D004566:Electrodes; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006498:Hepatectomy / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D010865:Pilot Projects