Balloon-Occluded Radiofrequency Ablation as Bridge to TACE in the Treatment of Advanced HCC with Arterioportal Shunt

Roberto Iezzi; Alessandro Posa; Marco Santoro; Alessandro Tanzilli; Lucia Cerrito; Francesca Romana Ponziani; Maurizio Pompili; Antonio Grieco; Gian Ludovico Rapaccini; Antonio Gasbarrini; Riccardo Manfredi

doi:10.2174/1874471015666220223102426

Balloon-Occluded Radiofrequency Ablation as Bridge to TACE in the Treatment of Advanced HCC with Arterioportal Shunt

Curr Radiopharm. 2022;15(3):194-198. doi: 10.2174/1874471015666220223102426.

Authors

Roberto Iezzi^{1

2}, Alessandro Posa¹, Marco Santoro³, Alessandro Tanzilli¹, Lucia Cerrito⁴, Francesca Romana Ponziani⁴, Maurizio Pompili^{2

4}, Antonio Grieco^{2

5}, Gian Ludovico Rapaccini^{2

6}, Antonio Gasbarrini^{2

4}, Riccardo Manfredi^{1

2}

Affiliations

¹ Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia - U.O.C. Radiologia Diagnostica e Interventistica Generale, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, Rome 00168, Italy.
² Università Cattolica del Sacro Cuore, Rome, Italy.
³ Diagnostic Imaging, Azienda USL di Pescara, Pescara, Italy.
⁴ Dipartimento di Scienze Mediche e Chirurgiche - U.O.C. Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, Rome 00168, Italy.
⁵ Dipartimento di Scienze Mediche e Chirurgiche - U.O.C. Medicina Interna e del Trapianto di Fegato, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, Rome 00168, Italy.
⁶ Dipartimento di Scienze Mediche e Chirurgiche - U.O.C. Gastroenterologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, Rome 00168, Italy.

PMID: 35209837
DOI: 10.2174/1874471015666220223102426

Abstract

Background: Transarterial chemoembolization is the most widely used palliative treatment for unresectable hepatocellular carcinoma; however, arterioportal shunt represents a contraindication to this treatment.

Objective: The study aims to assess the feasibility of balloon-occluded radiofrequency ablation in the transitory resolution of an extensive arterioportal shunt in patients with advanced hepatocellular carcinoma as a bridge to safe and effective transarterial chemoembolization.

Methods: 12 consecutive patients advanced multinodular unilobar unresectable hepatocellular carcinoma with a target lesion larger than 5 cm (mean diameter 7.7 ± 1.4 cm), not suitable to transarterial chemoembolization due to extensive arterioportal shunt, were recruited. Balloon-occluded radiofrequency ablation of the hepatic area surrounding the shunt during occlusion of the artery supplying the shunt was performed, followed by lobar conventional chemoembolization. Intra/periprocedural complications were evaluated. Technical success was defined by the result of radiofrequency ablation in terms of immediate disappearance, reduction, or persistence of the shunt. Local efficacy of chemoembolization was evaluated at 1-month computed tomography according to m-RECIST criteria.

Results: Technical success was achieved in all patients. No major complications were observed. 1- month follow-up showed a mean necrotic diameter of 6.3 cm (range: 3.8-8.7 cm), with an acceptable procedural result and persistence of the shunt. An overall response rate was obtained in all patients, with 25% complete response and 75% partial response.

Conclusion: Balloon-occluded radiofrequency ablation of an arterioportal shunt in patients with advanced hepatocellular carcinoma can temporarily reduce shunting, allowing to perform safe and therapeutically useful chemoembolization, with satisfactory control of tumor growth.

Keywords: HCC; RFA; ablation; arterioportal shunt; chemoembolization; combined therapy.

MeSH terms

Carcinoma, Hepatocellular* / diagnostic imaging
Carcinoma, Hepatocellular* / pathology
Carcinoma, Hepatocellular* / therapy
Chemoembolization, Therapeutic* / methods
Combined Modality Therapy
Humans
Liver Neoplasms* / diagnostic imaging
Liver Neoplasms* / pathology
Liver Neoplasms* / therapy
Radiofrequency Ablation*
Radiopharmaceuticals
Retrospective Studies
Treatment Outcome

Substances

Radiopharmaceuticals