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

Chen-Chun Lin; Kar-Wai Lui; Wei-Ting Chen; Yi-Chung Hsieh; Ya-Ting Cheng; Wei Teng; Shi-Ming Lin

doi:10.1007/s00330-021-07729-9

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

Eur Radiol. 2021 Nov;31(11):8649-8661. doi: 10.1007/s00330-021-07729-9. Epub 2021 Apr 25.

Authors

Chen-Chun Lin¹, Kar-Wai Lui², Wei-Ting Chen¹, Yi-Chung Hsieh¹, Ya-Ting Cheng¹, Wei Teng¹, Shi-Ming Lin³

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.
² Department of Medical Imaging & Intervention, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
³ 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. lsmpaicyto@cloud.cgmh.org.tw.

PMID: 33895858
DOI: 10.1007/s00330-021-07729-9

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.

Keywords: Ablation techniques; Humans; Liver neoplasms; Propensity score; Retrospective studies.

MeSH terms

Carcinoma, Hepatocellular* / surgery
Catheter Ablation*
Humans
Liver Neoplasms* / surgery
Radiofrequency Ablation*
Retrospective Studies
Treatment Outcome