J Liver Cancer.  2025 Mar;25(1):91-98. 10.17998/jlc.2025.01.25.

Enhanced radiofrequency ablation for recurrent hepatocellular carcinoma post-transarterial chemoembolization: a prospective study utilizing twin internally cooled-perfusion electrodes

• Hwang S
• Kim JH
• Park SJ
• Yu SJ
• Kim YJ
• Yoon JH
• Lee JM

• KMID: 2567067
• DOI: http://doi.org/10.17998/jlc.2025.01.25

Abstract

Backgrounds/Aims
Radiofrequency ablation (RFA) is widely employed for managing recurrent hepatocellular carcinoma (HCC) following transarterial chemoembolization (TACE). However, local tumor progression (LTP) after treatment remains a significant challenge. This study evaluates the efficacy of saline-perfused bipolar RFA using twin internally cooled-perfusion (TICP) electrodes in managing recurrent HCC post-TACE.
Methods
Between September 2017 and January 2019, 100 patients with 105 nodules (mean diameter, 1.6±0.5 cm) were prospectively enrolled. Bipolar RFA with TICP electrodes was performed under ultrasound-computed tomography/magnetic resonance fusion guidance. The primary outcome was the 2-year cumulative incidence of LTP.
Results
The technical success and technique efficacy rates were 100% and 97%, respectively. During a median follow-up period of 34.0 months (range, 3-41), the estimated LTP rates were 13.3% at 1 year and 17.7% at 2 years. Progression-free survival rates were 37.8% and 27.7% at 1 year and 2 years, respectively.
Conclusions
Saline-perfused bipolar RFA using TICP electrodes demonstrates promising results for recurrent HCC after TACE, achieving high technical success and effective local tumor control rates.

Keyword

Carcinoma, hepatocellular; Radiofrequency ablation; Chemoembolization, therapeutic

Figure

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  Figure 1. Study diagram. RFA, radiofrequency ablation; TICP, twin internally cooled-perfusion.

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  Figure 2. Twin internally cooled-perfusion (TICP) electrodes. (A) Two 17-gauge electrodes connected to a multichannel radiofrequency generator (RF Medical Co., Seoul, Korea). (B) A schematic diagram of a twin internally cooled-perfusion electrode illustrating saline flow through two microholes (diameter, 0.02 mm) on the electrode surface. Arrows indicate the direction of saline injection into the tissue.

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  Figure 3. Successful technical efficacy achieved using two 17-gauge internally cooled-perfusion electrodes with radiofrequency ablation in bipolar mode in a 43-year-old male with hepatocellular carcinoma (HCC) and hepatitis B-related liver cirrhosis. (A) An arterial-phase CT scan reveals a 2.1-cm HCC (arrow) in segment VIII of the liver, located in an area previously treated with transarterial chemoembolization, with evidence of a locally recurrent lesion. (B) Technique efficacy was confirmed (arrow), with no local tumor progression observed on the 1-month follow-up CT scan. (C) A real-time US-CT fusion image illustrates the target tumor during the radiofrequency ablation procedure. The red cross is a marker that helps accurately target the index tumor in the real-time US-CT fusion image. CT, computed tomography; US, ultrasound.

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  Figure 4. Kaplan-Meier estimation of tumor progression and survival rates. (A) Kaplan-Meier curve illustrating the cumulative incidence of local tumor progression (LTP) over time. (B) Kaplan-Meier curve depicting progression-free survival rates, which encompass LTP, intrahepatic remote recurrence, and extrahepatic metastases.

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Reference

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