Objectives

To establish a modified strategy of the feeding artery ablation (FAA) procedure as an add-on to percutaneous radiofrequency ablation (RFA) for patients with hypervascular hepatocellular carcinoma (HCC), and to evaluate the outcomes.

Materials and methods

For this prospective, single-arm study, from June 2014 to August 2016, twenty-five patients with hypervascular HCC, 2–5 cm in diameter were treated by contrast-enhanced ultrasound (CEUS)-guided FAA before conventional RFA. Technical success of FAA and subsequent perfusion change of the tumor were evaluated by CEUS. Technical efficacy and ablation sizes were evaluated by CT/MRI at 1 month. Therapeutic outcomes, including local tumor progression (LTP), overall survival (OS), and recurrence-free survival (RFS) were evaluated using the Kaplan–Meier method.

Results

One or two target feeding arteries were visible on CEUS for 52.6% (61/116) of the hypervascular HCCs 2–5 cm in diameter. The technical success rate of the FAA was 100%; 13/25 (52.0%) target tumors were evaluated as complete perfusion response, while 12/25 (48.0%) were evaluated as partial perfusion response. The ablation volume was 41.9 ± 17.5 cm³ (14.9–78.2 cm³) and the ablative safety margin was 8.2 ± 1.9 mm (4–12 mm) at the 1-month evaluation. These parameters did not differ significantly between the complete and partial subgroups. The cumulative rates of LTP at 1-, 2-, and 3-year follow-ups were 0.0%, 4.2% and 4.2%, respectively. The 3-year OS and RFS were 70.3% vs. 59.8%, respectively. There were no treatment-related deaths. Major complications occurred in one patient (4.0%).

Conclusion

As an add-on to conventional percutaneous RFA, tailored CEUS-guided FAA can reduce tumor perfusion and provide good local control of HCC.

中文翻译：

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超声增强引导下的供血动脉消融术作为经改良消融技术和肿瘤灌注评估的经皮射频消融术治疗高血管性肝细胞癌的附加手段。

目标

建立改良的供血动脉消融（FAA）程序的策略，作为高血管肝细胞癌（HCC）患者的经皮射频消融（RFA）的附件，并评估结果。

材料和方法

对于这项前瞻性单臂研究，从2014年6月至2016年8月，在常规RFA之前，采用造影剂超声（CEUS）引导的FAA治疗了25例直径2–5 cm的高血管HCC患者。CEUS评估了FAA的技术成功和随后的肿瘤灌注变化。1个月时通过CT / MRI评估技术疗效和消融大小。使用Kaplan-Meier方法评估治疗结果，包括局部肿瘤进展（LTP），总生存期（OS）和无复发生存期（RFS）。

结果

在CEUS上可见一到两个目标喂养动脉，占直径2–5 cm的高血管HCC的52.6％（61/116）。FAA的技术成功率为100％；将13/25（52.0％）的目标肿瘤评估为完全灌注反应，而将12/25（48.0％）的肿瘤评估为部分灌注反应。在1个月的评估中，消融体积为41.9±17.5 cm ³（14.9-78.2 cm ³），消融安全裕度为8.2±1.9 mm（4-12 mm）。这些参数在完整和部分亚组之间没有显着差异。在1年，2年和3年的随访中LTP的累积率分别为0.0％，4.2％和4.2％。3年OS和RFS分别为70.3％和59.8％。没有与治疗有关的死亡。一名患者（4.0％）发生了严重并发症。

结论

作为常规经皮RFA的一项补充措施，定制的CEUS指导的FAA可以减少肿瘤灌注并提供对HCC的良好局部控制。