Percutaneous Microwave Tumor Coagulation for Hepatocellular Carcinomas with Interruption of Segmental Hepatic Blood Flow

Abstract

To assess the effect of hepatic artery occlusion with or without hepatic venous outflow interruption on coagulation diameter during percutaneous microwave coagulation therapy (PMCT) for hepatocellular carcinoma (HCC) by a prospective and randomized trial. Thirty-one patients with 36 HCCs (10-38 mm in diameter) were randomly separated into two treatment groups as follows: group 1 (14 tumors in 14 patients) was treated with PMCT in conjunction with both segmental hepatic artery embolization with gelatin sponge particles and temporary interruption of hepatic venous flow by means of a 6-F balloon catheter to reduce the portal venous flow; group 2 (22 tumors in 17 patients) was treated with PMCT with segmental hepatic artery embolization only. PMCT under ultrasound (US) guidance was performed with 2,450 MHz of microwave frequency at 40-60 W and a needle applicator 1.6 mm in diameter. The coagulated area was measured at the maximum diameter perpendicular to the needle tract on enhanced computed tomography (CT) performed immediately after PMCT. The local effect of the treatment was evaluated by follow-up enhanced CT (6-33 mo). Patients in group 1 had a significantly larger coagulation area (mean +/-SD = 42.9 mm +/- 8.3), with coagulation times of 5.3 min +/- 1.4, than patients in group 2 (32.6 mm +/- 8.0), with coagulation times of 4.2 min +/- 1.3 (P <.05). Follow-up enhanced CT showed no local enhancement of the tumor, indicating complete necrosis and no local recurrence, except for four tumors. There were no major complications after PMCT except liver abscess that developed after PMCT in one patient with pneumobilia. PMCT with combined hepatic arterial embolization and temporary hepatic venous flow interruption can coagulate significantly larger volumes of tumor than PMCT with only hepatic arterial embolization.