Adjuvant percutaneous radiofrequency ablation of feeding artery of hepatocellular carcinoma before treatment

Abstract

Aim: To evaluate the feasibility and efficacy of percutaneous radiofrequency ablation (RFA) of the feeding artery of hepatocellular carcinoma (HCC) in reducing the blood-flow-induced heat-sink effect of RFA.

Methods: A total of 154 HCC patients with 177 pathologically confirmed hypervascular lesions participated in the study and were randomly assigned into two groups. Seventy-one patients with 75 HCCs (average tumor size, 4.3 +/- 1.1 cm) were included in group A, in which the feeding artery of HCC was identified by color Doppler flow imaging, and were ablated with multiple small overlapping RFA foci [percutaneous ablation of feeding artery (PAA)] before routine RFA treatment of the tumor. Eighty-three patients with 102 HCC (average tumor size, 4.1 +/- 1.0 cm) were included in group B, in which the tumors were treated routinely with RFA. Contrast-enhanced computed tomography was used as post-RFA imaging, when patients were followed-up for 1, 3 and 6 mo.

Results: In group A, feeding arteries were blocked in 66 (88%) HCC lesions, and the size of arteries decreased in nine (12%). The average number of punctures per HCC was 2.76 +/- 1.12 in group A, and 3.36 +/- 1.60 in group B (P = 0.01). The tumor necrosis rate at 1 mo post-RFA was 90.67% (68/75 lesions) in group A and 90.20% (92/102 lesions) in group B. HCC recurrence rate at 6 mo post-RFA was 17.33% (13/75) in group A and 31.37% (32/102) in group B (P = 0.04).

Conclusion: PAA blocked effectively the feeding artery of HCC. Combination of PAA and RFA significantly decreased post-RFA recurrence and provided an alternative treatment for hypervascular HCC.

Figure 1

Schematic drawing of PAA using three small ablation foci at the area where the feeding artery entered the tumor, to block the blood supply of HCC.

Figure 2

A 65-year-old man with cirrhosis and Child-Pugh class A liver function. An HCC lesion was diagnosed during regular US examination. A: CT showed a tumor with a size of 3.2 cm × 3.0 cm in the right liver lobe; B: US showed a tumor (arrow) of 4.3 cm × 3.3 cm 3 mo later; C: CDFI showed blood flow into and around the tumor with a velocity of 56.7 cm/s; D: CDFI-guided PAA at the area where the feeding artery entered the tumor (arrow), to block the tumor blood supply; E: After PAA, CDFI showed that the previous feeding artery disappeared and no flow signal within HCC; F: After PAA, RFA was performed in the rest of the tumor; G: Contrast-enhanced CT (1 mo after treatment) showed an ablated area covering the previous tumor, without enhancement; H: Contrast CT (6 mo after treatment) showed no enhancement of the ablated area. The patient has survived more than 10 mo without tumor.

Figure 3

The Kaplan-Meier curves for 6-mo recurrence rate in the two groups.

Figure 4

A 72-year-old man with 10 years of hepatitis B was detected with HCC during routine examination. This patient could not tolerate most of the therapies because of old age and poor general condition. A: Contrast-enhanced CT showed a 3.7 cm × 3.5 cm mass and the feeding vessel (arrow); B: Contrast-enhanced US 2 mo later showed the tumor enlarged to a size of 5.2 cm × 4.2 cm; C: CDFI showed feeding vessels in and around the tumor with a flow velocity of 34.5 cm/s. PAA was performed under CDFI guidance; D: During PAA, a small amount of subcapsular hemorrhage (0.5 cm in depth) was noted; E: The amount of hemorrhage gradually reduced (arrow) after PAA finished; F: Contrast-enhanced CT (24 h after treatment) showed a necrotic area covering the tumor. A small amount of subcapsular hemorrhage was still be noted.