Percutaneous radiofrequency ablation therapy for patients with hepatocellular carcinoma during occlusion of hepatic blood flow. Comparison with standard percutaneous radiofrequency ablation therapy.

Abstract

The therapeutic efficacy of radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) is limited by the small volume of coagulation necrosis obtained at each activation of the RF system and the sometimes irregular burn shape due to the proximity of large vessels that have a cooling effect. To improve the efficacy of RFA, the authors designed RFA with balloon occlusion of the hepatic artery (balloon-occluded RFA). In this study, we investigated the efficacy of balloon-occluded RFA and compared the coagulation diameters obtained with balloon-occluded RFA and standard RFA. We retrospectively studied 31 patients with 42 HCC lesions measuring less than 4 cm in the greatest dimension. We performed balloon-occluded RFA for 12 patients (n = 15 nodules) and standard RFA for 19 patients (n = 27 nodules). Initial therapeutic efficacy was evaluated with dynamic computed tomography scan performed 2 weeks after one treatment. There were no significant differences in the ablation conditions such as the frequency of a fully expanded electrode, the number of needle insertions, application cycles, or treatment times between the two groups. However, the greatest dimension of the area coagulated by balloon-occluded RFA was significantly larger (greatest long-axis dimension, 36.6 +/- 3.8 mm; greatest short-axis dimension, 30.1 +/- 6.0 mm; n = 15 lesions) than that coagulated by standard RFA (greatest long-axis dimension, 26.7 +/- 6.4 mm; greatest short-axis dimension, 23.1 +/- 5.0 mm; n = 27 lesions; greatest long-axis dimension, P < 0.001; greatest short-axis dimension, P < 0.001). Balloon-occluded RFA is superior to standard RFA for the treatment of many hepatocellular lesions, especially when larger volumes of coagulation are required.