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European Radiology
Published in: European Radiology 2/2019

01-02-2019 | Interventional

Percutaneous cryoablation for perivascular hepatocellular carcinoma: Therapeutic efficacy and vascular complications

Authors: Ran Kim, Tae Wook Kang, Dong Ik Cha, Kyoung Doo Song, Min Woo Lee, Hyunchul Rhim, Hyo Keun Lim, Dong Hyun Sinn

Published in: European Radiology | Issue 2/2019

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Abstract

Objectives

To evaluate the therapeutic efficacy of and vascular complications associated with percutaneous cryoablation for the treatment of perivascular HCC.

Methods

Between August 2015 and September 2017, 58 consecutive patients (48 men, 10 women; mean age, 61.1 years; age range, 44–84 years) who underwent percutaneous cryoablation were included. All patients had a single perivascular HCC (mean size, 1.3 cm; Barcelona clinic liver cancer-stage 0 or A) that was in contact with hepatic vessels, ≥ 3 mm or larger in axial diameter. Local tumour progression (LTP) was estimated by the Kaplan-Meier method. In addition, several procedure-related vascular complications were evaluated immediately after treatment and during follow-up CT: peritumoral vessel thrombosis; infarction; aggressive intrasegmental recurrence (AIR) (the simultaneous development of ≥ 3 nodular or infiltrative tumours). The follow-up CT was performed in all patients 1 month after the procedure, and every 3 months thereafter.

Results

The median follow-up period was 22 months (range, 3–29 months). The technical success rate of cryoablation was 96.6% (56/58). The 1- and 2-year cumulative LTP rates were 3.6% and 14.6%, respectively. Although peritumoral vessel thrombosis occurred in 6.9% of cases (4/58), no cases of hepatic infarction were observed and AIR did not develop during follow-up. Half of the thombi in the peritumoral vessels immediately after cryoablation disappeared on follow-up CT images.

Conclusion

Cryoablation could be an effective tool for the treatment of perivascular HCC with a very low risk of vascular complications.

Key Points

• Cryoablation allowed a high technical success rate for perivascular HCC.
• Only 6.9% developed peritumoral vessel thrombosis without major vascular complications like infarction.
• Two-year cumulative LTP rate was 14.6%, without aggressive tumour recurrence on follow-up.
Literature
1.
Forner A, Llovet JM, Bruix J (2012) Hepatocellular carcinoma. Lancet 379:1245–1255CrossRef
2.
Lu DS, Raman SS, Limanond P et al (2003) Influence of large peritumoral vessels on outcome of radiofrequency ablation of liver tumors. J Vasc Interv Radiol 14:1267–1274CrossRef
3.
Kang TW, Lim HK, Lee MW, Kim YS, Choi D, Rhim H (2014) Perivascular versus nonperivascular small HCC treated with percutaneous RF ablation: retrospective comparison of long-term therapeutic outcomes. Radiology 270:888–899CrossRef
4.
Lu DS, Raman SS, Vodopich DJ, Wang M, Sayre J, Lassman C (2002) Effect of vessel size on creation of hepatic radiofrequency lesions in pigs: assessment of the "heat sink" effect. AJR Am J Roentgenol 178:47–51CrossRef
5.
Akahane M, Koga H, Kato N et al (2005) Complications of percutaneous radiofrequency ablation for hepato-cellular carcinoma: imaging spectrum and management. Radiographics 25(Suppl 1):S57–S68CrossRef
6.
Kang TW, Lim HK, Cha DI (2017) Aggressive tumor recurrence after radiofrequency ablation for hepatocellular carcinoma. Clin Mol Hepatol 23:95–101CrossRef
7.
Takada Y, Kurata M, Ohkohchi N (2003) Rapid and aggressive recurrence accompanied by portal tumor thrombus after radiofrequency ablation for hepatocellular carcinoma. Int J Clin Oncol 8:332–335CrossRef
8.
Nault JC, Sutter O, Nahon P, Ganne-Carrie N, Seror O (2017) Percutaneous treatment of hepatocellular carcinoma: State of the art and innovations. J Hepatol
9.
Kang TW, Lim HK, Lee MW et al (2015) Aggressive Intrasegmental Recurrence of Hepatocellular Carcinoma after Radiofrequency Ablation: Risk Factors and Clinical Significance. Radiology 276:274–285CrossRef
10.
Littrup PJ, Aoun HD, Adam B, Krycia M, Prus M, Shields A (2016) Percutaneous cryoablation of hepatic tumors: long-term experience of a large U. S. series. Abdom Radiol (NY) 41:767–780CrossRef
11.
Glazer DI, Tatli S, Shyn PB, Vangel MG, Tuncali K, Silverman SG (2017) Percutaneous Image-Guided Cryoablation of Hepatic Tumors: Single-Center Experience With Intermediate to Long-Term Outcomes. AJR Am J Roentgenol 209:1381–1389CrossRef
12.
Lee SM, Won JY, Lee DY et al (2011) Percutaneous cryoablation of small hepatocellular carcinomas using a 17-gauge ultrathin probe. Clin Radiol 66:752–759CrossRef
13.
Song KD, Lee MW, Rhim H et al (2016) Aggressive Intrasegmental Recurrence of Hepatocellular Carcinoma After Combined Transarterial Chemoembolization and Radiofrequency Ablation. AJR Am J Roentgenol 207:1122–1127CrossRef
14.
Wears RL (2002) Advanced statistics: statistical methods for analyzing cluster and cluster-randomized data. Acad Emerg Med 9:330–341CrossRef
15.
Korean Liver Cancer Study Group, National Cancer Center (2015) 2014 Korean Liver Cancer Study Group-National Cancer Center Korea practice guideline for the management of hepatocellular carcinoma. Korean J Radiol 16:465–522CrossRef
16.
Rhim H, Choi D, Kim YS, Lim HK, Choe BK (2010) Ultrasonography-guided percutaneous radiofrequency ablation of hepatocellular carcinomas: a feasibility scoring system for planning sonography. Eur J Radiol 75:253–258CrossRef
17.
Min JH, Lim HK, Lim S et al (2014) Radiofrequency ablation of very-early-stage hepatocellular carcinoma inconspicuous on fusion imaging with B-mode US: value of fusion imaging with contrast-enhanced US. Clin Mol Hepatol 20:61–70CrossRef
18.
Kang TW, Lim HK, Lee MW, Kim YS, Choi D, Rhim H (2013) 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 68:e641–e651CrossRef
19.
Kang TW, Lim HK, Lee MW et al (2016) Long-term Therapeutic Outcomes of Radiofrequency Ablation for Subcapsular versus Nonsubcapsular Hepatocellular Carcinoma: A Propensity Score Matched Study. Radiology 280:300–312CrossRef
20.
Kang TW, Kim JM, Rhim H et al (2015) Small Hepatocellular Carcinoma: Radiofrequency Ablation versus Nonanatomic Resection--Propensity Score Analyses of Long-term Outcomes. Radiology 275:908–919CrossRef
21.
Ahmed M, Solbiati L, Brace CL et al (2014) Image-guided tumor ablation: standardization of terminology and reporting criteria--a 10-year update. J Vasc Interv Radiol 25(1691-1705):e1694
22.
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
23.
Wright AS, Sampson LA, Warner TF, Mahvi DM, Lee FT Jr (2005) Radiofrequency versus microwave ablation in a hepatic porcine model. Radiology 236:132–139CrossRef
24.
Huang S, Yu J, Liang P et al (2014) Percutaneous microwave ablation for hepatocellular carcinoma adjacent to large vessels: a long-term follow-up. Eur J Radiol 83:552–558CrossRef
25.
Kim YS, Rhim H, Lim HK, Choi D, Lee WJ, Kim SH (2007) Hepatic infarction after radiofrequency ablation of hepatocellular carcinoma with an internally cooled electrode. J Vasc Interv Radiol 18:1126–1133CrossRef
26.
Song KD, Lim HK, Rhim H et al (2015) Repeated Hepatic Resection versus Radiofrequency Ablation for Recurrent Hepatocellular Carcinoma after Hepatic Resection: A Propensity Score Matching Study. Radiology 275:599–608CrossRef
27.
Lee DH, Lee JM, Yoon JH, Kim YJ, Han JK (2017) Thermal injury-induced hepatic parenchymal hypoperfusion: risk of hepatocellular carcinoma recurrence after radiofrequency ablation. Radiology 282:880–891CrossRef
28.
Shiozawa K, Watanabe M, Takahashi M, Wakui N, Iida K, Sumino Y (2009) Analysis of patients with rapid aggressive tumor progression of hepatocellular carcinoma after percutaneous radiofrequency ablation. Hepatogastroenterology 56:1689–1695
29.
Kotoh K, Nakamuta M, Morizono S et al (2005) A multi-step, incremental expansion method for radio frequency ablation: optimization of the procedure to prevent increases in intra-tumor pressure and to reduce the ablation time. Liver Int 25:542–547CrossRef
30.
Hyun D, Cho SK, Shin SW et al (2016) Early stage hepatocellular carcinomas not feasible for ultrasound-guided radiofrequency ablation: comparison of transarterial chemoembolization alone and combined therapy with transarterial chemoembolization and radiofrequency ablation. Cardiovasc Intervent Radiol 39:417–425CrossRef
31.
Kang TW, Rhim H, Lee J et al (2016) Magnetic resonance imaging with gadoxetic acid for local tumour progression after radiofrequency ablation in patients with hepatocellular carcinoma. Eur Radiol 26:3437–3446CrossRef
32.
Kei SK, Rhim H, Choi D, Lee WJ, Lim HK, Kim YS (2008) Local tumor progression after radiofrequency ablation of liver tumors: analysis of morphologic pattern and site of recurrence. AJR Am J Roentgenol 190:1544–1551CrossRef
33.
Wang C, Wang H, Yang W et al (2015) Multicenter randomized controlled trial of percutaneous cryoablation versus radiofrequency ablation in hepatocellular carcinoma. Hepatology 61:1579–1590CrossRef
Metadata
Title
Percutaneous cryoablation for perivascular hepatocellular carcinoma: Therapeutic efficacy and vascular complications
Authors
Ran Kim
Tae Wook Kang
Dong Ik Cha
Kyoung Doo Song
Min Woo Lee
Hyunchul Rhim
Hyo Keun Lim
Dong Hyun Sinn
Publication date
01-02-2019
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 2/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-018-5617-6

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