Korean J Radiol.  2017 Oct;18(5):799-808. 10.3348/kjr.2017.18.5.799.

Percutaneous Dual-Switching Monopolar Radiofrequency Ablation Using a Separable Clustered Electrode: A Preliminary Study

• Choi TW
• Lee JM
• Lee DH
• Lee JH
• Yu SJ
• Kim YJ
• Yoon JH
• Han JK

• KMID: 2427216
• DOI: http://doi.org/10.3348/kjr.2017.18.5.799

Abstract

OBJECTIVE
To prospectively evaluate the safety and therapeutic effectiveness of dual-switching monopolar (DSM) radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma (HCC), and to retrospectively compare the results with those of single-switching monopolar (SSM) RFA in a historical control group.
MATERIALS AND METHODS
This study was approved by the Institutional Review Board, with informed consent obtained from all patients. Fifty-two HCC patients who underwent DSM-RFA using a separable clustered electrode and dual-generators were prospectively enrolled. Technical parameters, complications, technical success, technical effectiveness, and local tumor progression (LTP) rates were evaluated by means of post-procedural and follow-up imaging. Thereafter, the outcome of DSM-RFA was compared with those of 249 retrospectively included HCC patients treated with SSM-RFA.
RESULTS
There were two major complications (3.8%, 2/52) including pleural and pericardial effusion in the DSM-RFA group. The DSM-RFA yielded a 100% technical success rate, a 98.1% technical effectiveness rate, and a 4.3% 2-year LTP rate. In a retrospective comparison between the two groups, DSM-RFA created significantly larger ablation volume (4.20 ± 2.07 cm³/min vs. 3.03 ± 1.99 cm³/min, p < 0.01), and delivered higher energy (1.43 ± 0.37 kcal/min vs. 1.25 ± 0.50 kcal/min, p < 0.01) per given time, than SSM-RFA. There was no significant difference in major procedure-related complications (3.8% vs. 4.4%) and technical effectiveness rate (98.1% vs. 96.4%) between the two groups (p = 1.00). In addition, the 2-year LTP rate of DSM-RFA and SSM-RFA were 4.3% and 10.1%, respectively (p = 0.15).
CONCLUSION
DSM-RFA using a separable clustered electrode is safe and provides high local tumor control and good preliminary clinical outcome for small HCCs, which are at least comparable to those of SSM-RFA.

Keyword

Liver; Hepatocellular carcinoma; Local ablation therapy; Radiofrequency ablation; Therapeutic efficacy

MeSH Terms

Aged
Carcinoma, Hepatocellular/mortality/*surgery
Catheter Ablation/adverse effects/instrumentation/*methods
Electrodes
Female
Humans
Liver Neoplasms/mortality/*surgery
Male
Middle Aged
Pericardial Effusion/etiology
Pleural Effusion/etiology
Retrospective Studies
Serum Albumin/analysis
Survival Rate
Serum Albumin

Figure

• 

  Fig. 1 Radiofrequency ablation devices and diagrams of radiofrequency energy delivery patterns during SSM- and DSM-RFA.Photograph of three-channel dual-generator (VIVA Multi®) (A) and separable clustered electrode (Octopus®) (B), and records of applied current, power output, and impedance during SSM-RFA (C) and DSM-RFA (D). C. In SSM mode, RF energy was delivered to one of three electrodes and was automatically switched to another electrode based on impedance values. D. In DSM mode, RF energy was alternatively delivered to one or pair of electrodes based on tissue impedance changes, similar to SSM-RFA. DSM = dual-switching monopolar, RFA = radiofrequency ablation, SSM = single-switching monopolar

• 

  Fig. 2 Life-table survival curve of local tumor progression-free survival in patients treated with DSM and SSM-RFA.One- and two-year local tumor progression-free survival rates of DSM-RFA group vs. SSM-RFA group were 97.9% vs. 94.6% and 95.7% vs. 89.9%, respectively. p value was 0.149, which was calculated using log-rank test.

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