Korean J Radiol.  2013 Oct;14(5):733-742. 10.3348/kjr.2013.14.5.733.

Computed Tomographic-Guided Radiofrequency Ablation of Recurrent or Residual Hepatocellular Carcinomas around Retained Iodized Oil after Transarterial Chemoembolization

• Koh YH
• Choi JI
• Kim HB
• Kim MJ

• KMID: 1711427
• DOI: http://doi.org/10.3348/kjr.2013.14.5.733

Abstract

OBJECTIVE
To assess the clinical efficacy, safety, and risk factors influencing local tumor progression, following CT-guided radiofrequency ablation (RFA) of recurrent or residual hepatocellular carcinoma (HCC), around iodized oil retention.
MATERIALS AND METHODS
Sixty-four patients (M : F = 51 : 13, 65.0 +/- 8.2 years old) with recurrent or residual HCC (75 index tumors, size = 14.0 +/- 4.6 mm) had been treated by CT-guided RFA, using retained iodized oil as markers for targeting. The technical success, technique effectiveness rate and complications of RFA were then assessed. On pre-ablative and immediate follow-up CT after RFA, we evaluated the size of enhancing index tumors and iodized oil retention, presence of abutting vessels, completeness of ablation of iodized oil retention, and the presence of ablative margins greater than 5 mm. Also, the time interval between transarterial chemoembolization and RFA was assessed. The cumulative local tumor progression rate was calculated using the Kaplan-Meier method, and the Cox proportional hazards model was adopted, to clarify the independent factors affecting local tumor progression.
RESULTS
The technical success and technique effectiveness rate was 100% and 98.7%, respectively. Major complications were observed in 5.6%. The cumulative rates of local tumor progression at 1 and 2 years were 17.5% and 37.5%, respectively. In multivariate analyses, partial ablation of the targeted iodized oil retention was the sole independent predictor of a higher local tumor progression rate.
CONCLUSION
CT-guided RFA of HCC around iodized oil retention was effective and safe. Local tumor progression can be minimized by complete ablation of not only index tumors, but targeted iodized oil deposits as well.

Keyword

Hepatocellular carcinoma; Radiofrequency ablation; Computed tomography; Iodized oil; Local tumor progression

MeSH Terms

Aged
Carcinoma, Hepatocellular/*radiography
Catheter Ablation/*methods
Chemoembolization, Therapeutic/*methods
Fat Emulsions, Intravenous
Female
Humans
*Iodized Oil
Liver Neoplasms/mortality/radiography/*therapy
Male
Middle Aged
Neoplasm Recurrence, Local/*radiography
Republic of Korea/epidemiology
Surgery, Computer-Assisted/methods
Survival Rate/trends
Tomography, X-Ray Computed/*methods
Treatment Outcome
Fat Emulsions, Intravenous
Iodized Oil

Figure

• 

  Fig. 1 Schematic diagrams illustrating complete and partial ablation of area of iodized oil retention for targeting. A. Complete ablation of area of iodized oil retention for targeting. Ablated area (dashed circle) completely covers marginal local tumor progression/residual tumor (black circle) and iodized oil retention area (white circle) that were used as target for CT-guided RFA. B. Partial ablation of area of iodized oil retention for targeting. Ablated area (dashed circle) completely covers local tumor progression/residual tumor (black circle). However, iodized oil retention area (white circle), used as target for CT-guided RFA, is not completely covered by ablated area. RFA = radiofrequency ablation

• 

  Fig. 2 Complete ablation of enhancing tumor, and iodized oil retention, in 60 year-old man with multinodular hepatocellular carcinoma. A. On late arterial phase images of CT scan acquired before RFA, there is enhancing, nodular tumor, with partial retention of iodized oil in right hemiliver dome area (arrow). There are small iodized oil retentions in liver parenchyma. B. CT-guided RFA was performed (arrow). Radiofrequency electrode punctured center of iodized oil retention. C. On portal venous phase images of CT scan acquired immediately after RFA, enhancing tumor and areas of iodized oil retention are completely covered by low attenuation ablated area (arrow). In this patient, no local tumor progression was observed, during follow-up period of 24 months. RFA = radiofrequency ablation

• 

  Fig. 3 Complete ablation of marginal recurred tumor, but partial ablation of iodized oil retention, in 58 year-old man with multinodular hepatocellular carcinoma. A. In late arterial phase images of CT scan acquired before RFA, there is enhancing nodular tumor, abutting area of iodized oil retention in right anterior section of liver (arrow). B. CT-guided RFA was performed (arrowheads). Radiofrequency electrode punctured anterior margin of iodized oil retention area. C. In portal venous phase images of CT scan acquired immediately after RFA, enhancing tumor is completely covered by ablated area. However, area of iodized oil retention is not completely covered by low-attenuation ablated area. D. After four months, local tumor progression was observed in posterior region of iodized oil retention area (arrow), which was not covered by ablated area. RFA = radiofrequency ablation

• 

  Fig. 4 Diaphragm defect and herniated colon as major complication, in 68 year-old woman with single nodular hepatocellular carcinoma. A. There is enhancing index tumor in S8 of cirrhotic liver (arrow). Minor iodized oil retention is noted in posteromedial region of tumor. Significant ascites is also observable. B. CT-guided RFA was performed through transpulmonary route, and targeted using iodized oil retention as marker. C. CT image three months after D. There is large defect of diaphragm (arrow heads), and herniated right colon in right hemithorax (arrows). Right hemicolectomy was required in this patient, due to ischemic change in right hemicolon. RFA = radiofrequency ablation

• 

  Fig. 5 Kaplan-Meier curves, showing significant differences in local tumor progression rate. Local tumor progression rate was significantly better in cases of complete ablation of targeted iodized oil retention areas, than cases of partial ablation (complete ablation = solid line, partial ablation = dotted line). P-values are calculated by log-rank test.

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