Radiofrequency ablation combined with transcatheter arterial embolisation in rabbit liver: investigation of the ablation zone according to the time interval between the two therapies

Abstract

Objectives: This study was designed to evaluate the extent of the radiofrequency ablation zone in relation to the time interval between transcatheter arterial embolisation (TAE) and radiofrequency ablation (RFA) and, ultimately, to determine the optimal strategy of combining these two therapies for hepatocellular carcinoma. Methods: 15 rabbits were evenly divided into three groups: Group A was treated with RFA alone; Group B was treated with TAE immediately followed by RFA; and Group C was treated with TAE followed by RFA 5 days later. All animals underwent perfusion CT (PCT) scans immediately after RFA. Serum liver transaminases were measured to evaluate acute liver damage. Animals were euthanised for pathological analysis of ablated tissues 10 days after RFA. Non-parametric analyses were conducted to compare PCT indices, the RFA zone and liver transaminase levels among the three experimental groups. Results: Group B showed a significantly larger ablation zone than the other two groups. Arterial liver perfusion and hepatic perfusion index represented well the perfusion decrease after TAE on PCT. Although Group B showed the most elevated liver transaminase levels at 1 day post RFA, the enzymes decreased to levels that were not different from the other groups at 10 days post-RFA. Conclusions: When combined TAE and RFA therapy is considered, TAE should be followed by RFA as quickly as possible, as it can be performed safely without serious hepatic deterioration, despite the short interval between the two procedures.

Combined transarterial chemoembolization and radiofrequency ablation for small treatment-naïve hepatocellular carcinoma infeasible for ultrasound-guided radiofrequency ablation: long-term outcomes

“…First, TACE and subsequent RFA was performed in a single session without time delay in this study, whereas RFA was performed one week after TACE in the previous one. An animal study investigating the ablation zone according to time interval between two treatments reported that a single-session combination could create a larger ablation zone than a dual-session combination (21). Thus, there might be a difference in LTP rates between single-session and dual-session combinations.…”

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

“…Although TACE seemed to have higher CR rate theoretically, most embolization agents remained in the tumor only for a few weeks [28] and led to reperfusion of the tumor which might be construed as CR immediately after embolization. Based on this reason, some authors suggested Transcatheter Arterial Embolization (TAE) or TACE should be followed by RFA as quickly as possible to create a larger ablation volume [29,30]. However, it was not practical to apply combined treatment with RFA and TACE in most clinical settings.…”

Ablation plus Transarterial Embolic Therapy for Hepatocellular Carcinoma Larger than 3 cm: Science, Evidence, and Future Directions

“…[16][17][18] The sequential timing of administration may also be an influential factor, as TAE followed immediately by RFA in a single session showed a significantly larger volume of ablation than dual-session administration of TAE followed by RFA 5 days later (4.72 AE 2.61 vs. 2.43 AE 1.05 [p ¼ 0.008]). 19 In addition to the aforementioned synergism, tumor staining during TAE or TACE with ethiodized oil, retained iodinated contrast, or radiopaque beads enhances tumor conspicuity for improved targeting of treatment margins during thermal ablation. 20…”