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Switching monopolar radiofrequency ablation improves long-term outcomes of medium-sized hepatocellular carcinoma

  • Hepatobiliary-Pancreas
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

Radiofrequency ablation (RFA) of medium-sized (3–5 cm) hepatocellular carcinoma (HCC) is suboptimal. Switching monopolar RFA (SW-RFA) enlarges the ablative volume to better cover larger tumors. This study aims to compare the long-term outcomes of medium-sized HCC treated by either SW-RFA or single-monopolar RFA (S-RFA).

Methods

We retrospectively reviewed 139 cases (147 medium-size HCC) between 2008 and 2014. Under propensity score matching, a total of 43 paired patients with medium-size HCC and balanced clinical variables treated by either SW-RFA or S-RFA were selected for comparison.

Results

SW-RFA showed a higher rate of achieving an adequate safety margin (p = 0.002). After a mean follow-up period of 40.4 months, SW-RFA produced significantly lower global RFA failure rates (p < 0.001) and better overall survival (p = 0.005) compared to S-RFA. SW-RFA was independently associated with a decreased risk of global RFA failure (hazard ratio [HR]: 0.136, 95% confidence interval [CI]: 0.030–0.607, p = 0.009) and improved overall survival (HR: 0.337, 95% CI: 0.152–0.747, p = 0.007). By last follow-up, the SW-RFA group maintained a superior tumor-free rate (p = 0.010) and fewer progressions to Barcelona Clinic Liver Cancer stage C (p = 0.011). Major complication rates were comparable in both groups (SW-RFA: 2.3% vs. S-RFA: 4.7%, p = 1.000).

Conclusions

The switching multi-monopolar ablation technique could be beneficial for patients with medium-sized HCCs given sustained control of larger tumors with better overall survival.

Key Points

• Switching monopolar ablation could provide a sustained local tumor control and better overall survival than single-monopolar ablation for the medium-sized hepatocellular carcinoma.

• Compared to single-monopolar ablation, switching monopolar ablation could create a larger homogeneous coagulation volume by using a shorter total ablation time to achieve a higher rate of adequate safety margin for a medium-sized HCC.

• Patients with medium-sized HCC can be maintained at a higher rate of tumor-free status and at a lower risk of progression into BCLC stage C in the follow-up period after ablation by switching monopolar than by single-monopolar ablation.

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Abbreviations

AFP:

Alpha-fetoprotein

AUC:

Area under the curve

BCLC:

Barcelona Clinic Liver Cancer

ECOG PS:

Eastern Cooperative Oncology Group Performance Status

HCC:

Hepatocellular carcinoma

HR:

Hazard ratio

LTP:

Local tumor progression

PSM:

Propensity score matching

RFA :

Radiofrequency ablation

SIR:

Society of Interventional Radiology

S-RFA:

Single-monopolar radiofrequency ablation

SW-RFA:

Switching monopolar radiofrequency ablation

TACE :

Trans-arterial chemoembolization

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Acknowledgements

The authors thank HCC case manager Ching-Ting Wang, Hsiu-Ying Chai, and all the members of the Cancer Center of Chang Gung Memorial Hospital for their invaluable help.

Funding

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

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Authors and Affiliations

  1. Division of Hepatology, Liver Research Unit, Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsin St., Kwei-Shan, Taoyuan, Taiwan, 333

    Chen-Chun Lin, Wei-Ting Chen, Yi-Chung Hsieh, Ya-Ting Cheng, Wei Teng & Shi-Ming Lin

  2. Department of Medical Imaging & Intervention, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan

    Kar-Wai Lui

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Correspondence to Shi-Ming Lin.

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Guarantor

The scientific guarantor of this publication is Shi-Ming Lin.

Division of Hepatology, Liver Research Unit, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkuo; Chang Gung University 5, Fu-Hsin St., Kwei-Shan, Taoyuan, Taiwan 333

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Chang Gung Medical Foundation Institutional Review Board, IRB No. 201700101B0

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• case-control study

• performed at one institution

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Lin, CC., Lui, KW., Chen, WT. et al. Switching monopolar radiofrequency ablation improves long-term outcomes of medium-sized hepatocellular carcinoma. Eur Radiol 31, 8649–8661 (2021). https://doi.org/10.1007/s00330-021-07729-9

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  • DOI: https://doi.org/10.1007/s00330-021-07729-9

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