Abstract

Purpose

To assess the use of optimized radiofrequency (RF) to achieve larger, spherical ablation volumes with short application duration for hepatocellular carcinoma (HCC).

Materials and methods

Twenty-two patients (M:F = 17:5, median age 69.6 year, range 63–88) with 28 HCCs due to HCV + liver cirrhosis underwent RFA. 20/28 (71.4%) were tumors ≤3cm diameter, and 8/28 (28.6%) ranged from 3.2 to 4.2 cm. RF was applied using up to 2500mA via an optimized pulsing algorithm with real-time ultrasound monitoring to detect hyperechogenic changes. Single insertions of an internally cooled electrode were performed using exposed tips of 2 or 3 cm for 13 HCCs and 4 cm for 15 HCCs. All patients were followed-up for a minimum of 5 years with contrast-enhanced computed tomography (CECT).

Results

Technical success was achieved without adverse events in all cases. The mean ablation time was 8.5 ± 2.6 min. In 21/28 (75%), ablation duration ranged from 3 to 9 min, with 12 min duration applied in only 7/28 (25%). Mean coagulation diameters were 2.4 ± 0.14, 3.3 ± 0.62, and 4.4 ± 1.0, for 2, 3 and 4 cm electrodes, respectively (p < 0.01). The sphericity index was 74.9 ± 12.8 for 4 cm electrodes and 81.9 ± 8.0 for shorter electrodes (p = 0.091). At 5-year follow-up, no tumor ≤3 cm had recurrence and only 2/8 (25%) >3 cm tumors developed local progression. One patient had multifocal disease with no local progression.

Conclusion

Efficient delivery of RF energy can considerably decrease the ablation time in many instances while achieving larger, relatively spherical, and reproducible areas of ablation with extremely low rates of local tumor progression and adverse events.

中文翻译：

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HCC的经皮射频消融：使用单个内部冷却电极和优化的脉冲算法，可缩短消融时间并增加消融尺寸。

摘要

目的

评估使用优化的射频（RF）来实现较大的球形消融量，且肝细胞癌（HCC）的应用时间较短。

材料和方法

 22名因HCV +肝硬化而患有28例HCC的患者（M：F = 17：5，中位年龄69.6岁，范围63-88）接受了RFA。直径≤3cm的肿瘤为20/28（71.4％），而3.2至4.2 cm的肿瘤为8/28（28.6％）。通过优化的脉冲算法和实时超声监测，使用高达2500mA的RF来检测超回声变化。使用13 HCC的2或3 cm裸露尖端和15 HCC的4 cm裸露尖端进行内部冷却电极的单次插入。所有患者均接受了至少5年的对比增强计算机断层扫描（CECT）随访。

结果

在所有情况下都实现了技术成功，而没有发生不良事件。平均消融时间为8.5±2.6分钟。在21/28（75％）中，消融时间为3至9分钟，而在7/28（25％）中仅应用12分钟。2、3和4 cm电极的平均凝结直径分别为2.4±0.14、3.3±0.62和4.4±1.0（p  <0.01）。4 cm电极的球形指数为74.9±12.8，短电极的球形指数为81.9±8.0（p  = 0.091）。在5年的随访中，≤3 cm的肿瘤没有复发，只有2/8（25％）> 3 cm的肿瘤发生局部进展。一名患者患有多灶性疾病，无局部进展。

结论

在许多情况下，有效地传递射频能量可以显着减少消融时间，同时以相对较低的局部肿瘤进展和不良事件发生率，实现更大，相对球形，可再现的消融区域。