Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
European Radiology
Published in: European Radiology 2/2020

Open Access 01-02-2020 | Hepatocellular Carcinoma | Interventional

Feasibility, safety, and long-term efficacy of stereotactic radiofrequency ablation for tumors adjacent to the diaphragm in the hepatic dome: a case-control study

Authors: Peter Schullian, Daniel Putzer, Gregor Laimer, Elliot Levy, Reto Bale

Published in: European Radiology | Issue 2/2020

Login to get access

Abstract

Objectives

Achievement of adequate treatment margins may be challenging when the target is either difficult to visualize, awkward to access, or situated adjacent to vulnerable structures. Treatment of tumors located close to the diaphragm in the hepatic dome is challenging for percutaneous radiofrequency (RF) ablation for these reasons. The purpose was to assess the feasibility, safety, and clinical outcome of multi-probe stereotactic RF ablation (SRFA) of liver tumors in the subdiaphragmatic area.

Methods

Between 2006 and 2018, 177 patients (82 HCCs, 6 ICCs, and 89 metastatic tumors) underwent SRFA of 238 tumors abutting the diaphragm in the hepatic dome. For comparison, 177 patients were randomly selected from our database by the R package “MatchIt” for propensity score matching to compare treatment safety and efficacy in this retrospective, single-center study.

Results

Median treated tumor size was 2.2 cm (range 0.5 to 10 cm). SRFA was primarily successful for 232/238 (97.5%) tumors. Five tumors were successfully retreated, resulting in a secondary technical efficacy rate of 99.6%. Local tumor recurrence developed in 21 of 238 tumors (8.8%). The major ablation complication rate was 10.7% (22 of 204). Twelve (55%) of 22 major complications could be successfully treated by the interventional radiologist in the same anesthesia session. There was no significant difference in adverse events or disease control rates between the subdiaphragmatic tumors and matched controls.

Conclusions

SRFA is a safe and feasible option in the management of difficult-to-treat tumors abutting the diaphragm in the hepatic dome, with similar safety profile compared with matched controls.

Key Points

• RFA was primarily successful for 232/238 (97.5%) subdiaphragmatic dome tumors. Local tumor recurrence developed in 21 of 238 tumors (8.8%).
• The major complication rate directly related to ablation of the hepatic dome tumors was 10.7% (22 of 204). 12/22 (55%) of major complications could be successfully treated in the same anesthesia session.
• There was no significant difference in adverse events or disease control rates between the subdiaphragmatic tumors and matched controls.
Literature
1.
European Association For The Study Of The Liver, European Organisation For Research And Treatment Of Cancer (2012) EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 56:908–943
2.
Ahmed M, Solbiati L, Brace CL et al (2014) Image-guided tumor ablation: standardization of terminology and reporting criteria--a 10-year update. Radiology 273:241–260CrossRef
3.
Kim YS, Lee WJ, Rhim H, Lim HK, Choi D, Lee JY (2010) The minimal ablative margin of radiofrequency ablation of hepatocellular carcinoma (> 2 and < 5 cm) needed to prevent local tumor progression: 3D quantitative assessment using CT image fusion. AJR Am J Roentgenol 195:758–765CrossRef
4.
Head HW, Dodd GD 3rd, Dalrymple NC et al (2007) Percutaneous radiofrequency ablation of hepatic tumors against the diaphragm: frequency of diaphragmatic injury. Radiology 243:877–884CrossRef
5.
Kim YK, Kim CS, Lee JM, Chung GH, Chon SB (2006) Efficacy and safety of radiofrequency ablation of hepatocellular carcinoma in the hepatic dome with the CT-guided extrathoracic transhepatic approach. Eur J Radiol 60:100–107CrossRef
6.
Park BJ, Byun JH, Jin YH et al (2009) CT-guided radiofrequency ablation for hepatocellular carcinomas that were undetectable at US: therapeutic effectiveness and safety. J Vasc Interv Radiol 20:490–499CrossRef
7.
Shibata T, Maetani Y, Kubo T, Itoh K, Togashi K, Hiraoka M (2004) Transthoracic percutaneous radiofrequency ablation for liver tumors in the hepatic dome. J Vasc Interv Radiol 15:1323–1327CrossRef
8.
Toyoda M, Kakizaki S, Horiuchi K et al (2006) Computed tomography-guided transpulmonary radiofrequency ablation for hepatocellular carcinoma located in hepatic dome. World J Gastroenterol 12:608–611CrossRef
9.
Song I, Rhim H, Lim HK, Kim YS, Choi D (2009) Percutaneous radiofrequency ablation of hepatocellular carcinoma abutting the diaphragm and gastrointestinal tracts with the use of artificial ascites: safety and technical efficacy in 143 patients. Eur Radiol 19:2630–2640CrossRef
10.
Cho JY, Han HS, Yoon YS, Shin SH (2008) Feasibility of laparoscopic liver resection for tumors located in the posterosuperior segments of the liver, with a special reference to overcoming current limitations on tumor location. Surgery 144:32–38CrossRef
11.
Hori T, Nagata K, Hasuike S et al (2003) Risk factors for the local recurrence of hepatocellular carcinoma after a single session of percutaneous radiofrequency ablation. J Gastroenterol 38:977–981CrossRef
12.
Shirai K, Tamai H, Shingaki N et al (2011) Clinical features and risk factors of extrahepatic seeding after percutaneous radiofrequency ablation for hepatocellular carcinoma. Hepatol Res 41:738–745CrossRef
13.
Teratani T, Yoshida H, Shiina S et al (2006) Radiofrequency ablation for hepatocellular carcinoma in so-called high-risk locations. Hepatology 43:1101–1108CrossRef
14.
Widmann G, Schullian P, Haidu M, Fasser M, Bale R (2011) Targeting accuracy of CT-guided stereotaxy for radiofrequency ablation of liver tumours. Minim Invasive Ther Allied Technol 20:218–225CrossRef
15.
Bale R, Widmann G, Haidu M (2011) Stereotactic radiofrequency ablation. Cardiovasc Intervent Radiol 34:852–856CrossRef
16.
Bale R, Widmann G, Schullian P et al (2012) Percutaneous stereotactic radiofrequency ablation of colorectal liver metastases. Eur Radiol 22:930–937CrossRef
17.
Omary RA, Bettmann MA, Cardella JF et al (2003) Quality improvement guidelines for the reporting and archiving of interventional radiology procedures. J Vasc Interv Radiol 14:S293–S295CrossRef
18.
Vo Chieu VD, Werncke T, Hensen B, Wacker F, Ringe KI (2018) CT-guided microwave ablation of liver tumors in anatomically challenging locations. Cardiovasc Intervent Radiol 41:1520–1529CrossRef
19.
Rhim H, Lim HK (2009) Radiofrequency ablation for hepatocellular carcinoma abutting the diaphragm: the value of artificial ascites. Abdom Imaging 34:371–380CrossRef
20.
Tu JF, Ding YH, Chen L et al (2017) Iodine-125 brachytherapy prophylaxis after radiofrequency ablation cannot benefit patients in high risk of locoregional hepatocellular carcinoma recurrence. Sci Rep 7:3689CrossRef
21.
22.
Asvadi NH, Anvari A, Uppot RN, Thabet A, Zhu AX, Arellano RS (2016) CT-guided percutaneous microwave ablation of tumors in the hepatic dome: assessment of efficacy and safety. J Vasc Interv Radiol 27:496–502 quiz 503CrossRef
23.
Lopez PM, Villanueva A, Llovet JM (2006) Systematic review: evidence-based management of hepatocellular carcinoma--an updated analysis of randomized controlled trials. Aliment Pharmacol Ther 23:1535–1547CrossRef
24.
Kitai S, Kudo M, Minami Y et al (2008) A new prognostic staging system for hepatocellular carcinoma: value of the biomarker combined Japan integrated staging score. Intervirology 51(Suppl 1):86–94CrossRef
25.
Lencioni R, Cioni D, Donati F, Bartolozzi C (2001) Combination of interventional therapies in hepatocellular carcinoma. Hepatogastroenterology 48:8–14PubMed
26.
Zhang L, Yin X, Gan YH et al (2014) Radiofrequency ablation following first-line transarterial chemoembolization for patients with unresectable hepatocellular carcinoma beyond the Milan criteria. BMC Gastroenterol 14:11CrossRef
27.
Widmann G, Schullian P, Haidu M, Wiedermann FJ, Bale R (2010) Respiratory motion control for stereotactic and robotic liver interventions. Int J Med Robot 6:343–349CrossRef
28.
29.
Rhim H, Lim HK, Kim YS, Choi D (2008) Percutaneous radiofrequency ablation with artificial ascites for hepatocellular carcinoma in the hepatic dome: initial experience. AJR Am J Roentgenol 190:91–98CrossRef
30.
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRef
31.
Mulier S, Mulier P, Ni Y et al (2002) Complications of radiofrequency coagulation of liver tumours. Br J Surg 89:1206–1222CrossRef
32.
Kaneko H, Takagi S, Otsuka Y et al (2005) Laparoscopic liver resection of hepatocellular carcinoma. Am J Surg 189:190–194CrossRef
33.
D'Hondt M, Tamby E, Boscart I et al (2018) Laparoscopic versus open parenchymal preserving liver resections in the posterosuperior segments: a case-matched study. Surg Endosc 32:1478–1485CrossRef
34.
Castaing D, Vibert E, Ricca L, Azoulay D, Adam R, Gayet B (2009) Oncologic results of laparoscopic versus open hepatectomy for colorectal liver metastases in two specialized centers. Ann Surg 250:849–855CrossRef
35.
Xiao L, Xiang LJ, Li JW, Chen J, Fan YD, Zheng SG (2015) Laparoscopic versus open liver resection for hepatocellular carcinoma in posterosuperior segments. Surg Endosc 29:2994–3001CrossRef
36.
Bale R, Richter M, Dünser M, Levy E, Buchberger W, Schullian P (2018) Stereotactic radiofrequency ablation for breast cancer liver metastases. J Vasc Interv Radiol 29:262–267CrossRef
37.
Haidu M, Dobrozemsky G, Schullian P et al (2012) Stereotactic radiofrequency ablation of unresectable intrahepatic cholangiocarcinomas: a retrospective study. Cardiovasc Intervent Radiol 35:1074–1082CrossRef
38.
Bale R, Schullian P, Schmuth M, Widmann G, Jaschke W, Weinlich G (2016) Stereotactic radiofrequency ablation for metastatic melanoma to the liver. Cardiovasc Intervent Radiol 39:1128–1135CrossRef
39.
Kim SS, Kang TW, Kim M et al (2018) Initial radiofrequency ablation failure for hepatocellular carcinoma: repeated radiofrequency ablation versus transarterial chemoembolisation. Clin Radiol 73:216 e211–216 e218
40.
Llovet JM, Real MI, Montaña X et al (2002) Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 359:1734–1739CrossRef
Metadata
Title
Feasibility, safety, and long-term efficacy of stereotactic radiofrequency ablation for tumors adjacent to the diaphragm in the hepatic dome: a case-control study
Authors
Peter Schullian
Daniel Putzer
Gregor Laimer
Elliot Levy
Reto Bale
Publication date
01-02-2020
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 2/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-019-06399-y

Other articles of this Issue 2/2020

European Radiology 2/2020 Go to the issue

Cardiac

Computed tomography angiography-derived fractional flow reserve (CT-FFR) for the detection of myocardial ischemia with invasive fractional flow reserve as reference: systematic review and meta-analysis

Imaging Informatics and Artificial Intelligence

Deep learning with ultrasonography: automated classification of liver fibrosis using a deep convolutional neural network

Gastrointestinal

Assessment of primary liver carcinomas other than hepatocellular carcinoma (HCC) with LI-RADS v2018: comparison of the LI-RADS target population to patients without LI-RADS-defined HCC risk factors

Cardiac

Diagnostic performance of perivascular fat attenuation index to predict hemodynamic significance of coronary stenosis: a preliminary coronary computed tomography angiography study

Cardiac

Computed tomography for transcatheter tricuspid valve development

Oncology

Salvage RFA in patients with intrahepatic recurrence after major hepatic surgery for colorectal cancer liver metastases: mid-term outcome