Percutaneous radiofrequency ablation therapy with combined angiography andcomputed tomography assistance for patients with hepatocellular carcinoma

BACKGROUND. Radiofrequency ablation (RFA) for patients with hepatocellular carcinoma (HCC) has been reported previously. This technique is superior to percutaneous microwave coagulation therapy (PMCT) for the enlargement of t he necrotic area. Therefore, a few treatment sessions of RFA for patients w ith small HCC lesions measuring < 3 cm in greatest dimension can achieve co mplete necrosis. To achieve this with a one-treatment RFA session, the auth ors designed the technique of RFA with angiography combined with computed t omography (angio-CT) assistance. The advantages of this technique are that it is possible to detect small satellite nodules and to evaluate the real-t ime therapeutic effect immediately after RFA. METHODS. Ten patients with 12 HCC lesions measuring < 4 cm in greatest dime nsion underwent RFA with angio-CT assistance. The authors performed standar d RFA for six patients (seven tumors) and RFA with balloon occlusion of the hepatic artery (balloon-occluded RFA [BoRFA]) for four patients (five tumo rs). Final therapeutic efficacy was evaluated with dynamic CT scans perform ed 2 weeks after treatment. RESULTS. On CT arteriography (CTA) obtained immediately after treatment, a hyperattenuating ring around the nonenhanced region was apparent in all pat ients. On CT scans obtained 2 weeks after treatment, this ring disappeared, and the greatest dimension of the nonenhanced region was slightly larger t han that on the CTA obtained immediately after treatment. The authors achie ved complete eradication with one treatment session of RFA in 8 of 10 patie nts (80%). Local recurrence occurred in one patient 10 months after treatme nt. The greatest dimension of the area coagulated by BoRFA was significantl y larger (greatest long-axis dimension, 38.2 +/- 2.8 mm; greatest short-axi s dimension, 35.0 +/- 1.7 mm; n = 5 lesions) than without it (greatest long -axis dimension, 30.0 +/- 4.1 mm; greatest short-axis dimension, 27.0 +/- 4 .3 mm; n = 4 lesions; greatest long-axis dimension, P = 0.009; greatest sho rt-axis dimension, P = 0.006). No major complications occurred in any patie nt. CONCLUSIONS. The authors were able to achieve success with a single treatme nt session in patients with small HCC using RFA with angio-CT assistance. T hey consider that RFA with angio-CT assistance is a safe and effective tech nique for the treatment of patients with small HCC. (C) 2001 American Cance r Society.