Computed tomography fluoroscopy-guided radiofrequency ablation following intra-arterial iodized-oil injection for hepatocellular carcinomas invisible on ultrasonographic images

Abstract

We aimed to evaluate therapeutic outcomes of radiofrequency (RF) ablation following intra-arterial iodized-oil injection for hepatocellular carcinomas (HCCs) invisible on ultrasonographic (US) images. Informed consent was waived for this retrospective study approved by our institutional review board. Sixty-seven consecutive patients with 150 HCCs (mean diameter 1.3 ± 0.6 cm; range 0.5-4.2 cm) received 90 RF sessions following intra-arterial iodized-oil injection. Each patient had at least one HCC invisible on US images. Computed tomography (CT) fluoroscopy-guided RF ablation was performed within 1 week after the injection of iodized oil from feeding arteries of each tumor. Technical success was defined as a planned electrode placement and completion of ablation protocol. Technical success, complications, changes in liver function, local tumor progression, and survival were evaluated. All HCCs became visible on CT fluoroscopy after iodized-oil injection, and RF ablation was technically successful in all sessions (technical success rate, 100%, 90/90). Major complications occurred in 6 RF sessions (6.7%, 6/90), including hemorrhage (2.2%, 2/90), portal thrombosis (2.2%, 2/90), and pneumothorax (2.2%, 2/90). No significant deterioration in Child-Pugh score was found. The mean follow-up period was 23.2 ± 18.0 months. The cumulative local tumor progression rates and overall survival rates were, respectively, 3.9 and 82.7% at 1 year, 5.3 and 45.3% at 3 years, and 5.3 and 26.4% at 5 years. CT fluoroscopy-guided RF ablation following intra-arterial iodized-oil injection is a feasible, safe, and useful therapeutic option for HCCs invisible on US images.