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Percutaneous thermal ablation of subcapsular hepatocellular carcinomas: influence of tumor-surface contact and protrusion on therapeutic efficacy and safety

  • Oncology
  • Published:
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Abstract

Purpose

To evaluate therapeutic efficacy and complication of percutaneous thermal ablation of subcapsular hepatocellular carcinomas (HCCs), and how these may be influenced by the degree of tumor to liver surface contact and tumor protrusion from liver surface.

Materials and methods

Our retrospective study was approved by the Institutional Review Board. Between January 2006 and December 2013, 290 patients (82 women, 208 men; mean age, 64.5 years; range, 33–89 years) with 474 subcapsular (within 1 cm to the liver surface) HCCs (mean size, 23.7 mm; range, 6–71 mm) underwent percutaneous thermal ablation. The HCCs were divided into surface contact group (n = 243) and non-surface contact group (n = 231). The former was further subdivided into exophytic and non-exophytic HCCs. Technical success, primary technique efficacy, local tumor progression (LTP), and secondary technique efficacy rates were analyzed and compared by the chi-square test or Fisher exact test. Prognostic factors for LTP and secondary technique efficacy were assessed using the Cox regression model. Major complications were also assessed.

Results

With median follow-up of 15 months (range, 1–87 months), technical success and primary technique efficacy were 98.7% and 95.7% % in the non-surface contact group; 96.4% and 94.0% in the non-exophytic group; and 100% and 94.7% in the exophytic group (p > 0.05). Tumor size > 3 cm was a significant predictor for LTP, but not for secondary efficacy. Overall major complication rate was 3.8% (24/624) and was not different among the three groups.

Conclusion

Subcapsular HCCs can be effectively treated with thermal ablation techniques. Degree of tumor-surface contact including moderate protrusion does not appear to limit feasibility or procedure effectiveness.

Key Points

• Subcapsular HCCs can be effectively treated with thermal therapy when proper image-guided technique and assistive techniques are applied.

• Degree of tumor surface contact including moderate protrusion does not appear to limit feasibility or procedure effectiveness.

• Major complications after percutaneous thermal ablation of subcapsular HCCs such as tumor seeding can be minimized by avoiding breach of the tumor capsule exposed to the peritoneal surface and use of tract ablation.

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Abbreviations

AFP:

Alpha-fetoprotein

CI:

Confidence interval

CT:

Computed tomography

HCC:

Hepatocellular carcinoma

HR:

Hazard ratio

LTP:

Local tumor progression

MRI:

Magnetic resonance imaging

MWA:

Microwave ablation

RFA:

Radiofrequency ablation

TACE:

Transcatheter arterial chemoembolization

US:

Ultrasonography

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Funding

The authors state that this work has not received any funding.

Author information

Author notes

  1. Akeanong Worakitsitisatorn and David S. Lu contributed equally to the manuscript.

Authors and Affiliations

  1. Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA

    Akeanong Worakitsitisatorn, David S. Lu, Min Woo Lee, Nazanin H. Asvadi, Amin Moshksar, Alexander D. Yuen, Justin McWilliams & Steven S. Raman

  2. Department of Diagnostic and Interventional Radiology, Chulabhorn Hospital, 54 KamphaengPhet 6, Talat Bang Khen, Lak Si, Bangkok, 10210, Thailand

    Akeanong Worakitsitisatorn

  3. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, South Korea

    Min Woo Lee

Authors
  1. Akeanong Worakitsitisatorn
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  2. David S. Lu
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  3. Min Woo Lee
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  4. Nazanin H. Asvadi
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  5. Amin Moshksar
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Corresponding author

Correspondence to David S. Lu.

Ethics declarations

Guarantor

The scientific guarantor of this publication is David S. Lu, MD.

Conflict of interest

The authors of this manuscript declare relationships with the following companies:

David Lu, MD., has received funding for education and research, or consulting from Rita Medical, Boston Scientific, Covidien, and NeuWave Medical.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in:

1. Lee MW, Raman SS, Asvadi NH, Siripongsakun S, Hicks RM, Chen J, Worakitsitisatorn A, McWilliams J, Tong MJ, Finn RS, Agopian VG, Busuttil RW, Lu DSK. Radiofrequency ablation of hepatocellular carcinoma as bridge therapy to liver transplantation: A 10-year intention-to-treat analysis. Hepatology. 2017 Jun;65(6):1979-1990. doi: 10.1002/hep.29098. Epub 2017 Apr 28. PubMed PMID: 28170115.

Above study included patients who were listed for liver transplantation only and all tumor locations within the liver, while the current manuscript addresses only subcapsular HCC subjects, with majority not liver transplant candidates.

2. Thamtorawat S, Hicks RM, Yu J, Siripongsakun S, Lin WC, Raman SS, McWilliams

JP, Douek M, Bahrami S, Lu DS. Preliminary Outcome of Microwave Ablation of Hepatocellular Carcinoma: Breaking the 3-cm Barrier? J Vasc Interv Radiol. 2016 May;27(5):623-30. doi: 10.1016/j.jvir.2016.01.011. Epub 2016 Mar 21. PubMed PMID: 27013403.

Above article included only microwave ablation patients but all liver treatment sites, while the current manuscript addresses only subcapsular locations and includes both microwave and radiofrequency ablation subjects.

Methodology

• Retrospective

• Observational

• Performed at one institution

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Worakitsitisatorn, A., Lu, D.S., Lee, M.W. et al. Percutaneous thermal ablation of subcapsular hepatocellular carcinomas: influence of tumor-surface contact and protrusion on therapeutic efficacy and safety. Eur Radiol 30, 1813–1821 (2020). https://doi.org/10.1007/s00330-019-06497-x

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  • DOI: https://doi.org/10.1007/s00330-019-06497-x

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