Percutaneous radiofrequency ablation of tumor feeding artery before target tumor ablation may reduce local tumor progression in hepatocellular carcinoma

Abstract

BackgroundLocal tumor progression (LTP) in early-stage hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA) remains high. Tumor feeding artery ablation (FAA) before target tumor ablation was reported to reduce LTP in patients with HCC >3 cm. The aim of our study is to investigate whether FAA before target tumor ablation may reduce LTP in HCC <3 cm.MethodsWe retrospectively analysis the outcome of patients with HCC <3 cm undergoing FAA before target tumor ablation (N = 17) compared to direct RFA to target tumor alone (N = 35).ResultsFAA significantly reduces LTP (FAA vs. non-FAA: local tumor progression 17.6% vs. 48.6%, p = 0.038), but not in intrahepatic recurrence: 29.4% vs. 25.7%, p = 0.778; or in overall recurrence rate: 41.2% vs. 62.9%, p = 0.14). The cumulative 1-year and 2-year LTP rates in FAA group were 17.6% and 17.6%, while 11.4% and 42.9% in non-FAA group (p = 0.073), respectively. The cumulative overall recurrence rates at 1-year and 2-year were 29.4% and 35.3% in FAA group, while 14.3% and 57.1% in non-FAA group (p = 0.130), respectively.ConclusionsFAA before target tumor ablation may decrease LTP in HCC <3 cm. Further randomized control study will be helpful for validation.

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“…In this retrospective analysis of 52 patients with small (<3 cm) HCC, Cheng et al. [16] find that thermal ablation of the feeding artery before RFA against the target tumor significantly reduces local tumor progression.…”

Contrast-enhanced ultrasound-guided feeding artery ablation as add-on to percutaneous radiofrequency ablation for hypervascular hepatocellular carcinoma with a modified ablative technique and tumor perfusion evaluation

“…For example, real-time 3 D-CEUS could provide richer and more intuitive information on feeding arteries [16], which facilitated the procedure of FAA. Some researchers inserted the electrodes to the area where the arteries surrounded or entered the tumor [11][12][13]15], and another even punctured the nearby blood vessel directly [14]. In fact, this kind of manipulation has a risk of vessel damage, causing occlusion, thrombus, bleeding, or fatal liver infarction [31,32].…”

“…Another way to reduce or block tumor perfusion is the direct ablation of the target blood vessel before conventional RFA, as a one-step strategy. Previous studies have demonstrated that ultrasound-guided feeding artery ablation (FAA) before conventional RFA, either through percutaneous or laparoscopic access, could safely decrease LTP after HCC ablation [11][12][13][14][15]. However, most of the researchers only use color Doppler imaging to evaluate feeding artery structure and tumor perfusion change [11][12][13][14], which are obviously not precise.…”

“…Previous studies have demonstrated that ultrasound-guided feeding artery ablation (FAA) before conventional RFA, either through percutaneous or laparoscopic access, could safely decrease LTP after HCC ablation [11][12][13][14][15]. However, most of the researchers only use color Doppler imaging to evaluate feeding artery structure and tumor perfusion change [11][12][13][14], which are obviously not precise. Another major drawback of these previous studies is that operators do not make a clear distinction between feeding artery ablation and tumor ablation [11][12][13][14][15].…”

“…However, most of the researchers only use color Doppler imaging to evaluate feeding artery structure and tumor perfusion change [11][12][13][14], which are obviously not precise. Another major drawback of these previous studies is that operators do not make a clear distinction between feeding artery ablation and tumor ablation [11][12][13][14][15]. They usually insert one or more electrodes within the tumor and coagulate a relatively large amount of tissue including the feeding vessel, sometimes non-feeding vessels, and part of the tumor, which makes the accurate evaluation of perfusion change not possible and the independent effect of FAA confusing, or even worse, causes injury to non-feeding vessels and ischemia of normal liver parenchyma.…”