Scattered and rapid intrahepatic recurrences after radio frequency ablation for hepatocellular carcinoma

Abstract

Aim: To evaluate a series of patients with hepatocellular carcinoma (HCC) treated with several different protocols and devices.

Methods: We treated 138 patients [chronic hepatitis/liver cirrhosis (Child-Pugh A/B/C), 3/135 (107/25/3)] with two different devices and protocols: cool-tip needle [initial ablation at 60 W (standard method) (n=37) or at 40 W (modified method) (n=28)] or; ablation with a LeVeen needle using a standard single-step, full expansion (single-step) method (n=39) or a multi-step, incremental expansion (multi-step) method.

Results: Eleven patients experienced rapid and scattered recurrences 1 to 7 mo after the ablation. Nine patients were treated by the cool-tip original protocol (60 W) (9/37=24%) and the other two by the LeVeen single-step method (2/39=5%). The location of the recurrence was surrounding and limited to the site of ablation segment in three cases, and spread over one lobule or both lobules in the other eight cases. There was no recurrence in the patients treated with the modified cool-tip modified method (40 W) or the LeVeen multi-step method.

Conclusion: There is a risk of rapid and scattered recurrence after RFA, especially when the standard cool-tip procedure is used. Because such recurrence would worsen the prognosis, we recommend that modified protocols for the cool-tip and LeVeen needle methods should be used in clinical practice.

Figures

Figure 1

CT images of scattered recurrences after RFA. A: Recurrences around the ablated tumor after RFA (case 10 in Table 2); B: Multiple recurrences scattered over the whole liver after RFA (case 6 in Table 2). The white arrows indicate the ablated area without enhancement by contrast medium, and the black arrowheads indicate scattered recurrence with enhancement.

Figure 2

Angiographic images of scattered recurrences after RFA, which were treated by TACE in most of the cases. A: Multiple recurrences were located surrounding the ablated tumor (case 8 in Table 2). B: Multiple recurrences were scattered in the whole liver (case 9 in Table 2). In both patterns, recurrent tumors were almost equal in size.