Use of a New Algorithm with an Internally Cooled Electrode for Radiofrequency Ablation of Small Hepatocellular Carcinomas

Ho V. Nguyen, Kathleen A. Khong, John P. McGahan, Kai Ding, Machelle D. Wilson

Department of Public Health Sciences, University of California, Davis, USA.
Department of Radiology, University of California Davis Medical Center, Sacramento, USA.

DOI: 10.4236/ojrad.2013.34033                

Abstract

Purpose: To investigate the efficacy of a new algorithm to increase the volume of tissue ablation via gradual ramp-up of power using an internally cooled electrode for ablating hepatomas 3 cm or less. Materials and Methods: 44 patients with 62 hepatomas were treated from March 4, 2004 to May 24, 2009. Ablation with a gradual ramp-up of power was performed using a single needle with an internally cooled electrode. Evaluation for tumor response was performed with 4-phase CT at 24 hours and 3 months. All immediate and follow-up complications were recorded. Results: Complete tumor ablation was achieved in 86%. The ablation volumes were 16 cm³ +/- 12 cm³ for tumors <2 cm and 28 cm³ +/- 12 cm³ for tumors 2 - 3 cm. Out of 68 total ablation sessions, there were 2 major complications (pleural effusions) requiring intervention (thoracentesis). Conclusion: Compared with existing techniques using a constant full-power setting, ablation of small hepatomas using an algorithm of gradual ramp-up of power provides comparable rate of complete tumor ablation, adequate ablation volumes, and a low rate of complications that require treatment.

Keywords

Hepatocellular Carcinoma; Hepatoma; Radiofrequency Ablation; Internally-Cooled Electrode; Ramp-up; Full-Power; Algorithm

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	S. N. Goldberg, G. S. Gazelle, L. Solbiati, W. J. Rittman and P. R. Mueller, “Radiofrequency Tissue Ablation: Increased Lesion Diameter with a Perfusion Electrode,” Academic Radiology, Vol. 3, No. 8, 1996, pp. 636-644. http://dx.doi.org/10.1016/S1076-6332(96)80188-7
[2]	A. Guglielmi, A. Ruzzenente, M. Sandri, et al., “Radio Frequency Ablation for Hepatocellular Carcinoma in Cirrhotic Patients: Prognostic Factors for Survival,” Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract, Vol. 11, No. 2, 2007, pp. 143-149. http://dx.doi.org/10.1007/s11605-006-0082-y
[3]	R. Lencioni, D. Cioni, L. Crocetti, et al., “Early-Stage Hepatocellular Carcinoma in Patients with Cirrhosis: Long-term Results of Percutaneous Image-Guided Radiofrequency Ablation,” Radiology, Vol. 234, No. 3, 2005, pp. 961-967.
[4]	O. Seror, G. N’Kontchou, M. Tin-Tin-Htar, et al., “Radiofrequency Ablation with Internally Cooled versus Perfused Electrodes for the Treatment of Small Hepatocellular Carcinoma in Patients with Cirrhosis,” Journal of Vascular and Interventional Radiology: JVIR, Vol. 19, No. 5, 2008, pp. 718-724. http://dx.doi.org/10.1016/j.jvir.2008.01.007
[5]	T. Shibata, T. Shibata, Y. Maetani, H. Isoda and M. Hiraoka, “Radiofrequency Ablation of Small Hepatocellular Carcinoma: A Prospective Comparison of Internally Cooled Electrode and Expandable Electrode,” Radiology, Vol. 238, No. 1, 2006, pp. 346-353. http://dx.doi.org/10.1148/radiol.2381041848
[6]	S. Shiina, R. Tateishi, T. Arano, et al., “Radiofrequency Ablation for Hepatocellular Carcinoma: 10-Year Outcome and Prognostic Factors,” The American Journal of Gastroenterology, Vol. 107, No. 4, 2011, pp. 569-577. http://dx.doi.org/10.1038/ajg.2011.425
[7]	K. Yan, M. H. Chen, W. Yang, et al., “Radiofrequency Ablation of Hepatocellular Carcinoma: Long-Term Outcome and Prognostic Factors,” European Journal of Radiology, Vol. 67, No. 2, 2008, pp. 336-347. http://dx.doi.org/10.1016/j.ejrad.2007.07.007
[8]	S. M. Lin, C.J. Lin, H. J. Chung, C. W. Hsu and C. Y. Peng, “Power Roll-Off During Interactive Radiofrequency Ablation Can Enhance Necrosis When Treating Hepatocellular Carcinoma,” American Journal of Roentgenology, Vol. 180, No. 1, 2003, pp. 151-157. http://dx.doi.org/10.2214/ajr.180.1.1800151
[9]	J. P. McGahan, S. Loh, F. J. Boschini, et al., “Maximizing Parameters for Tissue Ablation by Using an Internally Cooled Electrode,” Radiology, Vol. 256, No. 2, 2010, pp. 397-405. http://dx.doi.org/10.1148/radiol.09090662
[10]	J. Bruix and M. Sherman, “Management of Hepatocellular Carcinoma: An Update,” Hepatology, Vol. 53, No. 3, 2011, pp. 1020-1022. http://dx.doi.org/10.1002/hep.24199
[11]	J. P. McGahan, L. Wright and J. Brock, “Occurrence and Value of the Color Doppler ‘Line Sign’ after Radiofrequency Ablation of Solid Abdominal Organs,” Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine, Vol. 30, No. 11, 2011, pp. 1491-1497.
[12]	D. Sacks, T. E. McClenny, J. F. Cardella and C. A. Lewis, “Society of Interventional Radiology Clinical Practice Guidelines,” Journal of Vascular and Interventional Radiology Vol. 14, No. 9, 2003, pp. S199-S202. http://dx.doi.org/10.1097/01.RVI.0000094584.83406.3e
[13]	J. H. Kim, P. N. Kim, H. J. Won and Y. M. Shin, “Percutaneous Radiofrequency Ablation Using Internally Cooled Wet Electrodes for the Treatment of Hepatocellular Carcinoma,” AJR American Journal of Roentgenology, Vol. 198, No. 2, 2012, pp. 471-476. http://dx.doi.org/10.2214/AJR.11.6583
[14]	J. Cha, D. Choi, M. W. Lee, et al., “Radiofrequency Ablation Zones in Ex Vivo Bovine and In Vivo Porcine Livers: Comparison of The Use of Internally Cooled Electrodes and Internally Cooled Wet Electrodes,” Cardiovascular and Interventional Radiology, Vol. 32, No. 6, 2009, pp. 1235-1240. http://dx.doi.org/10.1007/s00270-009-9600-0
[15]	S. N. Goldberg, P. F. Hahn, K. K. Tanabe, et al., “Percutaneous Radiofrequency Tissue Ablation: Does Perfusion-Mediated Tissue Cooling Limit Coagulation Necrosis?” Journal of vascular and Interventional Radiology: JVIR, Vol. 9, No. 1, 1998, pp. 101-111. http://dx.doi.org/10.1016/S1051-0443(98)70491-9
[16]	S. N. Goldberg, L. Solbiati, P. F. Hahn, et al., “LargeVolume Tissue Ablation with Radio Frequency by Using a Clustered, Internally Cooled Electrode Technique: Laboratory and Clinical Experience in Liver Metastases,” Radiology, Vol. 209, No. 2, 1998, pp. 371-379.
[17]	J. P. McGahan and G. D. Dodd, “Radiofrequency Ablation of the Liver: Current Status,” AJR American Journal of Roentgenology, Vol. 176, No. 1, 2001, pp. 3-16. http://dx.doi.org/10.2214/ajr.176.1.1760003
[18]	G. D. Dodd, M. S. Frank, M. Aribandi, S. Chopra and K. N. Chintapalli, “Radiofrequency Thermal Ablation: Computer Analysis of the Size of the Thermal Injury Created by Overlapping Ablations,” AJR American Journal of Roentgenology, Vol. 177, No. 4, 2001, pp. 777-782. http://dx.doi.org/10.2214/ajr.177.4.1770777