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No-Touch Multi-bipolar Radiofrequency Ablation for the Treatment of Subcapsular Hepatocellular Carcinoma ≤ 5 cm Not Puncturable via the Non-tumorous Liver Parenchyma

  • Clinical Investigation
  • Interventional Oncology
  • Published:
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Abstract

Purpose

The percutaneous ablation of subcapsular hepatocellular carcinoma (S-HCC) may involve a risk of complications such as hemorrhage and tumor seeding, mainly linked to the direct tumor puncture often inevitable with mono-applicator ablation devices. The purpose of this study was to assess the efficacy and safety of no-touch multi-bipolar radiofrequency ablation (NTMBP-RFA) for the treatment of S-HCC ≤ 5 cm not puncturable via the non-tumorous liver parenchyma.

Materials and methods

Between September 2007 and December 2014, 58 consecutive patients (median age: 63 years [46–86], nine females) with 59 S-HCC ≤ 5 cm (median diameter: 25 mm [10–50 mm]), not puncturable via the non-tumorous liver parenchyma, were treated with NTMBP-RFA. Response and follow-up were assessed by CT or MRI. Complications were graded using the Cardiovascular and Interventional Radiological Society of Europe classification. Overall local tumor progression (OLTP)-free survival was assessed using the Kaplan–Meier method. A Cox proportional model evaluated the factors associated with OLTP. Signs of peritoneal or parietal tumor seeding were noted during follow-up imaging studies.

Results

A complete ablation was achieved in 57/58 patients (98.3%) after one (n = 51) or two (n = 6) procedures. Three patients (5.2%) experienced complications (sepsis, cirrhosis decompensation; CIRSE grade 2 or 3). After a median follow-up period of 30.5 months [1–97], no patients had tumor seeding. The 1, 2 and 3-year OLTP-free survival rates were 98%, 94% and 91%, respectively. No factors were associated with OLTP.

Conclusion

NTMBP-RFA is a safe and effective treatment for S-HCC not puncturable via the non-tumorous liver parenchyma.

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References

  1. Liver EA for the S of the, Cancer EO for R and T of. EASL–EORTC Clinical Practice Guidelines: management of hepatocellular carcinoma. J Hepatol. 2012;56:908–43.

    Article  Google Scholar 

  2. Livraghi T, Solbiati L, Meloni MF, Gazelle GS, Halpern EF, Goldberg SN. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology. 2003;226:441–51.

    Article  Google Scholar 

  3. Bertot LC, Sato M, Tateishi R, Yoshida H, Koike K. Mortality and complication rates of percutaneous ablative techniques for the treatment of liver tumors: a systematic review. Eur Radiol. 2011;21:2584–96.

    Article  Google Scholar 

  4. Giorgio A, Merola MG, Montesarchio L, Merola F, Gatti P, Coppola C, et al. Percutaneous radiofrequency ablation of hepatocellular carcinoma in cirrhosis: analysis of complications in a single centre over 20 years. Br J Radiol. 2017;90:20160804.

    Article  Google Scholar 

  5. Rhim H, Yoon K-H, Lee JM, Cho Y, Cho J-S, Kim SH, et al. Major complications after radio-frequency thermal ablation of hepatic tumors: spectrum of imaging findings. Radiogr Rev Publ Radiol Soc N Am Inc. 2003;23:123–34 discussion 134–6.

    Google Scholar 

  6. Jaskolka JD, Asch MR, Kachura JR, Ho CS, Ossip M, Wong F, et al. Needle tract seeding after radiofrequency ablation of hepatic tumors. J Vasc Interv Radiol. 2005;16:485–91.

    Article  Google Scholar 

  7. Kang TW, Lim HK, Lee MW, Kim Y-S, Rhim H, Lee WJ, et al. Long-term therapeutic outcomes of radiofrequency ablation for subcapsular versus nonsubcapsular hepatocellular carcinoma: a propensity score matched study. Radiology. 2016;280:300–12.

    Article  Google Scholar 

  8. Kim YJ, Raman SS, Yu NC, Busuttil RW, Tong M, Lu DSK. Radiofrequency ablation of hepatocellular carcinoma: can subcapsular tumors be safely ablated? AJR Am J Roentgenol. 2008;190:1029–34.

    Article  Google Scholar 

  9. Llovet JM, Vilana R, Brú C, Bianchi L, Salmeron JM, Boix L, et al. Increased risk of tumor seeding after percutaneous radiofrequency ablation for single hepatocellular carcinoma. Hepatol Baltim Md. 2001;33:1124–9.

    Article  CAS  Google Scholar 

  10. Livraghi T, Lazzaroni S, Meloni F, Solbiati L. Risk of tumour seeding after percutaneous radiofrequency ablation for hepatocellular carcinoma. Br J Surg. 2005;92:856–8.

    Article  CAS  Google Scholar 

  11. Sartori S, Tombesi P, Macario F, Nielsen I, Tassinari D, Catellani M, et al. Subcapsular liver tumors treated with percutaneous radiofrequency ablation: a prospective comparison with nonsubcapsular liver tumors for safety and effectiveness. Radiology. 2008;248:670–9.

    Article  Google Scholar 

  12. Poon RT-P, Ng KK-C, Lam C-M, Ai V, Yuen J, Fan S-T. Radiofrequency ablation for subcapsular hepatocellular carcinoma. Ann Surg Oncol. 2004;11:281–9.

    Article  Google Scholar 

  13. Francica G, Meloni MF, de Sio I, Smolock AR, Brace CL, Iadevaia MD, et al. Radiofrequency and microwave ablation of subcapsular hepatocellular carcinoma accessed by direct puncture: safety and efficacy. Eur J Radiol. 2016;85:739–43.

    Article  Google Scholar 

  14. Zhong-yi Z, Wei Y, Kun Y, Ying D, Wei W, Jung-chieh L, et al. Needle track seeding after percutaneous radiofrequency ablation of hepatocellular carcinoma: 14-year experience at a single centre. Int J Hyperth. 2017;33:454–8.

    Article  Google Scholar 

  15. Bonny C, Abergel A, Gayard P, Chouzet S, Ughetto S, Slim K, et al. Radiofrequency ablation of hepatocellular carcinoma in patients with cirrhosis. Gastroentérol Clin Biol. 2002;1220:665.

    Google Scholar 

  16. Crocetti L, de Baere T, Lencioni R. Quality improvement guidelines for radiofrequency ablation of liver tumours. Cardiovasc Interv Radiol. 2010;33:11–7.

    Article  Google Scholar 

  17. Seror O, N’Kontchou G, Nault J-C, Rabahi Y, Nahon P, Ganne-Carrié N, et al. Hepatocellular carcinoma within Milan criteria: no-touch multibipolar radiofrequency ablation for treatment-long-term results. Radiology. 2016;280:981.

    Article  Google Scholar 

  18. Seror O. Percutaneous hepatic ablation: what needs to be known in 2014. Diagn Interv Imaging. 2014;95:665–75. 

    Article  CAS  Google Scholar 

  19. Seror O, N’Kontchou G, Ibraheem M, Ajavon Y, Barrucand C, Ganne N, et al. Large (>or=5.0-cm) HCCs: multipolar RF ablation with three internally cooled bipolar electrodes–initial experience in 26 patients. Radiology. 2008;248:288–96. 

    Article  Google Scholar 

  20. Mohkam K, Dumont P-N, Manichon A-F, Jouvet J-C, Boussel L, Merle P, et al. No-touch multibipolar radiofrequency ablation vs. surgical resection for solitary hepatocellular carcinoma ranging from 2 to 5 cm. J Hepatol. 2018;68:1172–80.

    Article  Google Scholar 

  21. N’Kontchou G, Nault J-C, Sutter O, Bourcier V, Coderc E, Grando V, et al. Multibipolar radiofrequency ablation for the treatment of mass-forming and infiltrative hepatocellular carcinomas > 5 cm: long-term results. Liver Cancer. 2018;1–14. 

    Google Scholar 

  22. Bruix J, Sherman M. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53:1020–2.

    Article  Google Scholar 

  23. Motoyama T, Ogasawara S, Chiba T, Higashide T, Yokota H, Kanogawa N, et al. Coronal reformatted CT images contribute to the precise evaluation of the radiofrequency ablative margin for hepatocellular carcinoma. Abdom Imaging. 2014;39:262–8.

    Article  Google Scholar 

  24. Filippiadis DK, Binkert C, Pellerin O, Hoffmann RT, Krajina A, Pereira PL. Cirse quality assurance document and standards for classification of complications: the cirse classification system. Cardiovasc Interv Radiol. 2017;40:1141–6.

    Article  CAS  Google Scholar 

  25. Kang TW, Lim HK, Lee MW, Kim Y-S, Choi D, Rhim H. First-line radiofrequency ablation with or without artificial ascites for hepatocellular carcinomas in a subcapsular location: local control rate and risk of peritoneal seeding at long-term follow-up. Clin Radiol. 2013;68:e641–51.

    Article  CAS  Google Scholar 

  26. Patidar Y, Singhal P, Gupta S, Mukund A, Sarin SK. Radiofrequency ablation of surface v/s intraparenchymal hepatocellular carcinoma in cirrhotic patients. Indian J Radiol Imaging. 2017;27:496.

    Article  Google Scholar 

  27. Hocquelet A, Seror O, Blanc J-F, Frulio N, Salut C, Nault J-C, et al. Transarterial chemoembolization for early stage hepatocellular carcinoma decrease local tumor control and overall survival compared to radiofrequency ablation. Oncotarget. 2017;8:32190.

    Article  Google Scholar 

  28. Mohamed M, Katz AW, Tejani MA, Sharma AK, Kashyap R, Noel MS, et al. Comparison of outcomes between SBRT, yttrium-90 radioembolization, transarterial chemoembolization, and radiofrequency ablation as bridge to transplant for hepatocellular carcinoma. Adv Radiat Oncol. 2016;1:35–42.

    Article  Google Scholar 

  29. Park SI, Kim IJ, Lee SJ, Shin MW, Shin W, Chung YE, et al. Angled cool-tip electrode for radiofrequency ablation of small superficial subcapsular tumors in the liver: a feasibility study. Korean J Radiol. 2016;17:742.

    Article  Google Scholar 

  30. Hocquelet A, Aubé C, Rode A, Cartier V, Sutter O, Manichon AF, et al. Comparison of no-touch multi-bipolar vs. monopolar radiofrequency ablation for small HCC. J Hepatol. 2017;66:67–74.

    Article  Google Scholar 

  31. Seror O, N’Kontchou G, Van Nhieu JT, Rabahi Y, Nahon P, Laurent A, et al. Histopathologic comparison of monopolar versus no-touch multipolar radiofrequency ablation to treat hepatocellular carcinoma within Milan criteria. J Vasc Interv Radiol. 2014;25:599–607. 

    Article  Google Scholar 

  32. Stigliano R, Marelli L, Yu D, Davies N, Patch D, Burroughs AK. Seeding following percutaneous diagnostic and therapeutic approaches for hepatocellular carcinoma. What is the risk and the outcome? Cancer Treat Rev. 2007;33:437–47.

    Article  CAS  Google Scholar 

  33. Chang W, Lee JM, Lee SM, Han JK. No-touch radiofrequency ablation: a comparison of switching bipolar and switching monopolar ablation in ex vivo bovine liver. Korean J Radiol. 2017;18:279.

    Article  Google Scholar 

  34. Chang W, Lee JM, Yoon JH, Lee DH, Lee SM, Lee KB, et al. No-touch radiofrequency ablation using multiple electrodes: an in vivo comparison study of switching monopolar versus switching bipolar modes in porcine livers. PLoS ONE. 2017;12:e0176350.

    Article  Google Scholar 

  35. Patel PA, Ingram L, Wilson IDC, Breen DJ. No-touch wedge ablation technique of microwave ablation for the treatment of subcapsular tumors in the liver. J Vasc Interv Radiol. 2013;24:1257–62.

    Article  Google Scholar 

  36. Nault J-C, Sutter O, Nahon P, Ganne-Carrié N, Séror O. Percutaneous treatment of hepatocellular carcinoma: state of the art and innovations. J Hepatol. 2018;68:783–97.

    Google Scholar 

  37. Ziegle J, Audigier C, Krug J, Ali G, Kim Y, Boctor EM, et al. RF-ablation pattern shaping employing switching channels of dual bipolar needle electrodes: ex vivo results. Int J Comput Assist Radiol Surg. 2018;13:905–16.

    Article  Google Scholar 

  38. de la Serna S, Vilana R, Sánchez-Cabús S, Calatayud D, Ferrer J, Molina V, et al. Results of laparoscopic radiofrequency ablation for HCC. Could the location of the tumour influence a complete response to treatment? A single European centre experience. HPB. 2015;17:387–93.

    Article  Google Scholar 

  39. Kawamura Y, Ikeda K, Fukushima T, Hara T, Hosaka T, Kobayashi M, et al. Potential of a no-touch pincer ablation procedure for small hepatocellular carcinoma that uses a multipolar radiofrequency ablation system: an experimental animal study: no-touch ablation procedure for hepatic tumors. Hepatol Res. 2014;44:1234–40.

    Article  Google Scholar 

Download references

Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. Radiology Department, Hôpital Jean Verdier (APHP), Hôpitaux universitaires Paris-Seine-Saint-Denis, Assistfance Publique Hôpitaux de Paris, Avenue du 14 juillet, 93140, Bondy, France

    Arthur Petit, Eloi Varin, Nicolas Sellier, Olivier Seror & Olivier Sutter

  2. Diagnostic and Interventional Radiology Department, CHU Vaudois, Lausanne, Switzerland

    Arnaud Hocquelet

  3. Hepatology Department, Hôpital Jean Verdier, Hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Bondy, France

    Gisèle N’kontchou

  4. Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, communauté d’universités et établissements Sorbonne Paris cité, Paris, France

    Olivier Seror & Olivier Sutter

  5. Unité mixte de recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, Paris, France

    Olivier Seror

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  1. Arthur Petit
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Correspondence to Olivier Sutter.

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Petit, A., Hocquelet, A., N’kontchou, G. et al. No-Touch Multi-bipolar Radiofrequency Ablation for the Treatment of Subcapsular Hepatocellular Carcinoma ≤ 5 cm Not Puncturable via the Non-tumorous Liver Parenchyma. Cardiovasc Intervent Radiol 43, 273–283 (2020). https://doi.org/10.1007/s00270-019-02357-9

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