Computed Tomographic-Guided Radiofrequency Ablation of Recurrent or Residual Hepatocellular Carcinomas around Retained Iodized Oil after Transarterial Chemoembolization

Koh, Young Hwan,Choi, Joon-Il,Kim, Hyun Beom,Kim, Min Ju The Korean Society of Radiology 2013 KOREAN JOURNAL OF RADIOLOGY Vol.14 No.5

<P><B>Objective</B></P><P>To assess the clinical efficacy, safety, and risk factors influencing local tumor progression, following CT-guided radiofrequency ablation (RFA) of recurrent or residual hepatocellular carcinoma (HCC), around iodized oil retention.</P><P><B>Materials and Methods</B></P><P>Sixty-four patients (M : F = 51 : 13, 65.0 ± 8.2 years old) with recurrent or residual HCC (75 index tumors, size = 14.0 ± 4.6 mm) had been treated by CT-guided RFA, using retained iodized oil as markers for targeting. The technical success, technique effectiveness rate and complications of RFA were then assessed. On pre-ablative and immediate follow-up CT after RFA, we evaluated the size of enhancing index tumors and iodized oil retention, presence of abutting vessels, completeness of ablation of iodized oil retention, and the presence of ablative margins greater than 5 mm. Also, the time interval between transarterial chemoembolization and RFA was assessed. The cumulative local tumor progression rate was calculated using the Kaplan-Meier method, and the Cox proportional hazards model was adopted, to clarify the independent factors affecting local tumor progression.</P><P><B>Results</B></P><P>The technical success and technique effectiveness rate was 100% and 98.7%, respectively. Major complications were observed in 5.6%. The cumulative rates of local tumor progression at 1 and 2 years were 17.5% and 37.5%, respectively. In multivariate analyses, partial ablation of the targeted iodized oil retention was the sole independent predictor of a higher local tumor progression rate.</P><P><B>Conclusion</B></P><P>CT-guided RFA of HCC around iodized oil retention was effective and safe. Local tumor progression can be minimized by complete ablation of not only index tumors, but targeted iodized oil deposits as well.</P>

Computed Tomographic-Guided Radiofrequency Ablation of Recurrent or Residual Hepatocellular Carcinomas around Retained Iodized Oil after Transarterial Chemoembolization

고영환,최준일,김현범,김민주 대한영상의학회 2013 Korean Journal of Radiology Vol.14 No.5

Objective: To assess the clinical efficacy, safety, and risk factors influencing local tumor progression, following CT-guided radiofrequency ablation (RFA) of recurrent or residual hepatocellular carcinoma (HCC), around iodized oil retention. Materials and Methods: Sixty-four patients (M : F = 51 : 13, 65.0 ± 8.2 years old) with recurrent or residual HCC (75 index tumors, size = 14.0 ± 4.6 mm) had been treated by CT-guided RFA, using retained iodized oil as markers for targeting. The technical success, technique effectiveness rate and complications of RFA were then assessed. On pre-ablative and immediate follow-up CT after RFA, we evaluated the size of enhancing index tumors and iodized oil retention, presence of abutting vessels, completeness of ablation of iodized oil retention, and the presence of ablative margins greater than 5 mm. Also, the time interval between transarterial chemoembolization and RFA was assessed. The cumulative local tumor progression rate was calculated using the Kaplan-Meier method, and the Cox proportional hazards model was adopted, to clarify the independent factors affecting local tumor progression. Results: The technical success and technique effectiveness rate was 100% and 98.7%, respectively. Major complications were observed in 5.6%. The cumulative rates of local tumor progression at 1 and 2 years were 17.5% and 37.5%, respectively. In multivariate analyses, partial ablation of the targeted iodized oil retention was the sole independent predictor of a higher local tumor progression rate. Conclusion: CT-guided RFA of HCC around iodized oil retention was effective and safe. Local tumor progression can be minimized by complete ablation of not only index tumors, but targeted iodized oil deposits as well.

Treatment Outcomes of Percutaneous Radiofrequency Ablation for Hepatocellular Carcinomas: Effects of the Electrode Type and Placement Method

Park Jiyeon,Lee Min Woo,Ahn Soo Hyun,Han Seungchul,Min Ji Hye,Cha Dong Ik,Song Kyoung Doo,Kang Tae Wook,Rhim Hyunchul 대한영상의학회 2023 Korean Journal of Radiology Vol.24 No.8

Objective: To investigate the association among the electrode placement method, electrode type, and local tumor progression (LTP) following percutaneous radiofrequency ablation (RFA) for small hepatocellular carcinomas (HCCs) and to assess the risk factors for LTP. Materials and Methods: In this retrospective study, we enrolled 211 patients, including 150 males and 61 females, who had undergone ultrasound-guided RFA for a single HCC < 3 cm. Patients were divided into four combination groups of the electrode type and placement method: 1) tumor-puncturing with an internally cooled tip (ICT), 2) tumor-puncturing with an internally cooled wet tip (ICWT), 3) no-touch with ICT, and 4) no-touch with ICWT. Univariable and multivariable Cox proportional-hazards regression analyses were performed to evaluate the risk factors for LTP. The major RFA-related complications were assessed. Results: Overall, 83, 34, 80, and 14 patients were included in the ICT, ICWT, no-touch with ICT, and no-touch with ICWT groups, respectively. The cumulative LTP rates differed significantly among the four groups. Compared to tumor puncturing with ICT, tumor puncturing with ICWT was associated with a lower LTP risk (adjusted hazard ratio [aHR] = 0.11, 95% confidence interval [CI] = 0–0.88, P = 0.034). However, the cumulative LTP rate did not differ significantly between tumorpuncturing with ICT and no-touch RFA with ICT (aHR = 0.34, 95% CI = 0.03–1.62, P = 0.188) or ICWT (aHR = 0.28, 95% CI = 0–2.28, P = 0.294). An insufficient ablative margin was a risk factor for LTP (aHR = 6.13, 95% CI = 1.41–22.49, P = 0.019). The major complication rates were 1.2%, 0%, 2.5%, and 21.4% in the ICT, ICWT, no-touch with ICT, and no-touch with ICWT groups, respectively. Conclusion: ICWT was associated with a lower LTP rate compared to ICT when performing tumor-puncturing RFA. An insufficient ablation margin was a risk factor for LTP.

No-Touch Radiofrequency Ablation Using Twin Cooled Wet Electrodes for Recurrent Hepatocellular Carcinoma Following Locoregional Treatments

Hong Seong Jun,Kim Jae Hyun,Yoon Jeong Hee,Park Jeong Hoan,Yoon Jung-Hwan,Kim Yoon Jun,Yu Su Jong,Cho Eun Ju,Lee Jeong Min 대한영상의학회 2024 Korean Journal of Radiology Vol.25 No.5

Objective: To evaluate the therapeutic outcomes of no-touch radiofrequency ablation (NT-RFA) using twin cooled wet (TCW) electrodes in patients experiencing recurrent hepatocellular carcinoma (HCC) after undergoing locoregional treatments. Materials and Methods: We conducted a prospective, single-arm study of NT-RFA involving 102 patients, with a total of 112 recurrent HCCs (each ≤ 3 cm). NT-RFA with TCW electrodes was implemented under the guidance of ultrasonography (US)-MR/CT fusion imaging. If NT-RFA application proved technically challenging, conversion to conventional tumor puncture RFA was permitted. The primary metric for evaluation was the mid-term cumulative incidence of local tumor progression (LTP) observed post-RFA. Cumulative LTP rates were estimated using the Kaplan-Meier method. Multivariable Cox proportional hazard regression was used to explore factors associated with LTP. Considering conversion cases from NT-RFA to conventional RFA, intention-to-treat (ITT; including all patients) and per-protocol (PP; including patients not requiring conversion to conventional RFA alone) analyses were performed. Results: Conversion from NT-RFA to conventional RFA was necessary for 24 (21.4%) out of 112 tumors. Successful treatment was noted in 111 (99.1%) out of them. No major complications were reported among the patients. According to ITT analysis, the estimated cumulative incidences of LTP were 1.9%, 6.0%, and 6.0% at 1, 2, and 3 years post-RFA, respectively. In PP analysis, the cumulative incidence of LTP was 0.0%, 1.3%, and 1.3% at 1, 2, and 3 years, respectively. The number of previous locoregional HCC treatments (adjusted hazard ratio [aHR], 1.265 per 1 treatment increase; P = 0.004), total bilirubin (aHR, 7.477 per 1 mg/dL increase; P = 0.012), and safety margin ≤ 5 mm (aHR, 9.029; P = 0.016) were independently associated with LTP in ITT analysis. Conclusion: NT-RFA using TCW electrodes is a safe and effective treatment for recurrent HCC, with 6.0% (ITT analysis) and 1.3% (PP analysis) cumulative incidence of LTP at 2 and 3-year follow-ups.

Prediction of Local Tumor Progression after Radiofrequency Ablation (RFA) of Hepatocellular Carcinoma by Assessment of Ablative Margin Using Pre-RFA MRI and Post-RFA CT Registration

Jeong Hee Yoon,Jeong Min Lee,Ernst Klotz,우현식,유미혜,주이진,이은선,Joon Koo Han 대한영상의학회 2018 Korean Journal of Radiology Vol.19 No.6

Objective: To evaluate the clinical impact of using registration software for ablative margin assessment on pre-radiofrequency ablation (RFA) magnetic resonance imaging (MRI) and post-RFA computed tomography (CT) compared with the conventional side-by-side MR-CT visual comparison. Materials and Methods: In this Institutional Review Board-approved prospective study, 68 patients with 88 hepatocellulcar carcinomas (HCCs) who had undergone pre-RFA MRI were enrolled. Informed consent was obtained from all patients. Pre-RFA MRI and post-RFA CT images were analyzed to evaluate the presence of a sufficient safety margin (≥ 3 mm) in two separate sessions using either side-by-side visual comparison or non-rigid registration software. Patients with an insufficient ablative margin on either one or both methods underwent additional treatment depending on the technical feasibility and patient’s condition. Then, ablative margins were re-assessed using both methods. Local tumor progression (LTP) rates were compared between the sufficient and insufficient margin groups in each method. Results: The two methods showed 14.8% (13/88) discordance in estimating sufficient ablative margins. On registration software-assisted inspection, patients with insufficient ablative margins showed a significantly higher 5-year LTP rate than those with sufficient ablative margins (66.7% vs. 27.0%, p = 0.004). However, classification by visual inspection alone did not reveal a significant difference in 5-year LTP between the two groups (28.6% vs. 30.5%, p = 0.79). Conclusion: Registration software provided better ablative margin assessment than did visual inspection in patients with HCCs who had undergone pre-RFA MRI and post-RFA CT for prediction of LTP after RFA and may provide more precise risk stratification of those who are treated with RFA.

Assessment of Local Tumor Progression After Image-Guided Thermal Ablation for Renal Cell Carcinoma

Park Byung Kwan 대한영상의학회 2024 Korean Journal of Radiology Vol.25 No.1

Focal enhancement typically suggests local tumor progression (LTP) after renal cell carcinoma is percutaneously ablated. However, evaluating findings that are false positive or negative of LTP is less familiar to radiologists who have little experience with renal ablation. Various imaging features are encountered during and after thermal ablation. Ablation procedures and previous follow-up imaging should be reviewed before determining if there is LTP. Previous studies have focused on detecting the presence or absence of focal enhancement within the ablation zone. Therefore, various diagnostic pitfalls can be experienced using computed tomography or magnetic resonance imaging examinations. This review aimed to assess how to read images during or after ablation procedures, recognize imaging features of LTP and determine factors that influence LTP.

Laparoscopic radiofrequency ablation versus percutaneous radiofrequency ablation for subphrenic hepatocellular carcinoma

곽민환,이민우,Ko Seong Eun,임현철,강태욱,송경두,김종만,Choi Gyu Seong 대한초음파의학회 2022 ULTRASONOGRAPHY Vol.41 No.3

Purpose: Radiofrequency ablation is a curative treatment option for very early-stage or earlystage hepatocellular carcinoma (HCC). However, percutaneous radiofrequency ablation (PRFA) for subphrenic tumors is technically challenging. Laparoscopic radiofrequency ablation (LRFA) has been used to overcome this disadvantage. This study compared the treatment outcomes between LRFA and PRFA for subphrenic HCC.Methods: This retrospective study screened patients who underwent PRFA or LRFA for subphrenic HCC between 2013 and 2018. Therapeutic outcomes, including local tumor progression (LTP), intrahepatic distant recurrence (IDR), extrahepatic metastasis (EM), disease-free survival (DFS), and overall survival (OS), were compared between the two groups.Results: Thirty patients in the PRFA group and 23 patients in the LRFA group were included. LTP was observed in six patients in the PRFA group (20%), but in no patients in the LRFA group. The cumulative LTP rates at 1, 3, and 5 years were 3.7%, 23.4%, and 23.4%, respectively, in the PRFA group and 0.0% in the LRFA group (P=0.015). The IDR, EM, and DFS rates were not significantly different between the two groups (P=0.304, P=0.175, and P=0.075, respectively). The OS rates at 1, 3, and 5 years were 96.6%, 85.7%, and 71.6%, respectively, in the PRFA group and 100%, 95.7%, and 95.7%, respectively, in the LRFA group (P=0.049).Conclusion: LRFA demonstrated better therapeutic outcomes than did PRFA for subphrenic tumors in terms of LTP and OS. Therefore, LRFA can be considered as the first-line treatment option for subphrenic HCC.

Risk Factor of the Recurrence for Hepatocellular Carcinoma after Intra-Operative Radiofrequency Ablation

( Myung Hee Kim ),( Hyuk Soo Eun ),( Min Seong Kim ),( Min Kyung Baek ),( Deok Yeong Kim ),( Jae Ho Park ),( Woo Sun Rou ),( Jong Seok Joo ),( Eaum Seok Lee ),( Seok Hwan Kim ),( In Sang Song ),( Byun 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: Despite the highly complete tumor necrosis rate of radiofrequency ablation (RFA), tumor recurrence, either locoregional or newly developing lesion, was regarded as significant issue. Recurrence reduction through appropriate procedure selection as well as patients’ selection could improve survival of patients. Therefore, we analyzed the conditional factor for recurrence after intra-operative RFA treatment on hepatocellular carcinoma (HCC). Methods: We investigated 98 patients who were treated with intra-operative RFA as initial treatment for HCC. The mean follow-up period was 33 ± 14.5 months. We evaluated the disease-free survival of recurred patients, including local tumor progression (LTP) and intrahepatic distant recurrence (IDR). For these patients, multiple factors were assessed to their significance for recurrence and survival. Results: Almost baseline characteristics were not shown statistically significant difference, except for few factors between the groups. The incidence of overall recurrence was 47.9 %. LTP was found in 20 of 47 patients (20.4%) and occurred 4 - 33 months [median period: 14 months] after RFA. IDR was found in 27 of 47 patients (27.5%) and occurred 6 - 88 months [median period: 22 months] after RFA. Interestingly, on multivariate analysis for whole recurred patients, serum α-fetoprotein (AFP) was significantly associated factor with recurrence of the tumor [P=0.006, 95% C.I.: 1.001-1.007, HR=1.004]. In addition, INR and Child-Pugh scores, factors representing severity of underlying liver disease status, were significantly associated with survival of the patients (P=0.039 and P=0.046). Especially, AFP was also significantly associated factor with patients’ survival. [P=0.016, 95% C.I.: 1.001-1.006, HR=1.004]. After subgroup analysis for recurred patients, we found that patients with higher AFP levels had more recurrence patterns of LTP rather than IDR. Conclusions: Patients with high AFP level received intraoperative RFA for HCC should be carefully followed-up and considered more active radical treatment modality because of higher risk of recurrence and mortality.