Solitary huge hepatocellular carcinomas 10 cm or larger may be completely ablated by repeated radiofrequency ablation combined with chemoembolization: Initial experience with 9 patients

Abstract

Abstract. The treatment of solitary huge hepatocellular carcinoma (SHHCC) larger than 10 cm remains a challenge. The aim of the present study was to assess the therapeutic effects of repeated radiofrequency ablation (RFA) combined with chemoembolization on SHHCC. This was a retrospective study based on data obtained from a prospectively collected database that included 9 SHHCC patients who underwent repeated RFA combined with chemoembolization between July 2008 and June 2011. A new management strategy for SHHCC was described. The mean tumor size of the patients was 11.5±1.0 cm. No technical failure occurred, no patient succumbed to the disease during this treatment and the median survival of all 9 patients was 34 months. Treatment of the 9 tumors required a mean of 8.2±1.5 sessions. The mean of RF applications per session was 5.3±0.9 and the mean time of one session was 165±30 min, including a mean time of RF application of 113±19 min. The SHHCCs were found to be completely ablated. The mean number of RFA for primary complete ablation was 7.0±0.9 sessions, and the mean time for primary complete ablation was 5.3±1.1 months. The overall survival rate was 100%. There were 4 actual 2-year survivors. Our data reveal that tactically and strategically performed RFA should be recommended to SHHCC patients who are not suitable or do not agree to surgery, with satisfactory efficacy and safety.

Repeated Radiofrequency Ablation Combined With Ablated Lesion Elimination and Transarterial Chemoembolization Improves the Outcome of Solitary Huge Hepatocellular Carcinomas 10 cm or Larger

“…In the past few years, we have observed a special subtype of HCC ≥10 cm, defined as SHHCC and exhibiting less metastatic capacity. 9 Yang et al 22 reported that the clinical and pathological characteristics and outcome after hepatic resection of some SHHCC cases are similar to those of small HCC, but significantly better than those of nodular HCC. However, the vast majority of such patients are not eligible for resection because of the severity of underlying cirrhosis when SHHCC is detected.…”

“…In the TACE/TAE + RF ablation group, we used the procedures described previously. 9 Briefly, a primary central massive ablation was performed, followed by peripheral repeated RF ablations. In the new strategy group, a treatment strategy including sequential treatments was carried out in 3 phases.…”

“…CT-guided RF ablation was performed using Cool-tip ACTC1525 or ACTC2025 electrodes under general anesthesia as described previously. 9 An RF generator (Covidien Healthcare, Dublin, Republic of Ireland) was used for RF ablation according to the manufacturer's protocol. We selected the appropriate electrode based on the size, geometry, and location of the index tumor.…”

“… 8 However, among huge HCCs, some subtypes of tumors present as solitary mass growing expansibly within an intact capsule or pseudocapsule, without major venous invasion. 9 , 10 Such subtypes of solitary huge HCCs (SHHCCs) still have the chance to be eradicated with the goal of achieving a prolonged survival.…”

“…Our primary results indicated that repeated RF ablation can be recommended for patients with SHHCC who are not suitable for surgery or refuse to receive surgical tumor removal, with acceptable efficacy and safety. 9 However, tumor recurrence or local tumor progression (LTP) remains a critical clinical issue for those patients with SHHCC who even achieved imaging-confirmed complete ablation. The most possible reason for high incidence of tumor recurrence lies in the fact that it is very difficult to obtain a sufficient ablative margin (AM) for such huge HCCs using repeated ablation alone.…”