Abstract
ObjectiveThis study was conducted to evaluate the outcomes of multi-channel switching RFA using a separable cluster electrode in patients with HCC.MethodsFrom November 2011 to July 2013, 79 patients with 98 HCCs < 5 cm were enrolled and treated with RFA using a multi-channel switching radiofrequency system and a separable cluster electrode under the guidance of a real-time fusion imaging system. The primary and secondary endpoints were the 3-year local tumor progression (LTP) rate and recurrence-free survival (RFS) rate, respectively. For post hoc analyses, LTP, RFS, and major complication rates were retrospectively compared with a historical control group treated with RFA using the same radiofrequency system but with multiple internally-cooled electrodes.ResultsThe technique success rate of the 98 tumors was 100%. Cumulative 1-year, 2-year, and 3-year LTP rates were 3.4%, 6.9%, and 12.4%, respectively. For patient-level data, cumulative 1-year, 2-year, and 3-year RFS rates were 83.9%, 68.6%, and 45.4%, respectively. On post hoc analyses, none of the baseline characteristics showed a significant difference between the separable cluster electrode and multiple internally-cooled electrodes group. Cumulative LTP and RFS rates of the two groups also showed no significant difference (p = 0.401 and p = 0.881, respectively). Finally, major complication rates of the separable cluster electrode group (5.0%, 4/79) and multiple internally-cooled electrodes group (5.9%, 4/74) were also comparable (p = 1.000).ConclusionSwitching monopolar RFA using a separable cluster electrode is a feasible and efficient technique for the treatment of HCCs smaller than 5 cm, providing comparable local tumor control to multiple internally-cooled electrodes.Trial RegistrationClinicalTrials.gov NCT02745483
Highlights
Radiofrequency ablation (RFA) has been widely utilized as an effective treatment option for hepatocellular carcinoma (HCC) as well as diverse liver metastases [1,2,3,4,5,6,7]
A previous meta-analysis study [12] reported that RF ablation performed with conventional overlapping RFA for early HCC using various kinds of electrodes provided a pooled estimate of 3-year survival of 74.8%, compared to 79.8% observed for surgical resection
Until now, RFA has been limited in achieving local tumor control for tumors larger than 3 cm compared with surgical resection due to its difficulty in creating a sufficiently large ablation volume including the target tumor and a 5−10 mm safety margin (3-year disease-free survival: 45.8% for surgery vs. 29.9% for RFA) [12]
Summary
Radiofrequency ablation (RFA) has been widely utilized as an effective treatment option for hepatocellular carcinoma (HCC) as well as diverse liver metastases [1,2,3,4,5,6,7]. RFA has been reported to provide better cost effectiveness than surgical resection, especially in patients with single, small HCCs 2 cm [9,10,11,12]. A previous meta-analysis study [12] reported that RF ablation performed with conventional overlapping RFA for early HCC using various kinds of electrodes provided a pooled estimate of 3-year survival of 74.8%, compared to 79.8% observed for surgical resection. Until now, RFA has been limited in achieving local tumor control for tumors larger than 3 cm compared with surgical resection due to its difficulty in creating a sufficiently large ablation volume including the target tumor and a 5−10 mm safety margin (3-year disease-free survival: 45.8% for surgery vs 29.9% for RFA) [12]. Various strategies have been recently employed to create a sufficient ablation zone, including the use of multi-tined electrodes (RITA Medical Systems, Mountain View, CA) to increase the active surface area [13, 14], clustered internally-cooled electrodes (Covidien, Burlington, Mass) to diminish charring [15, 16], perfusion electrodes to promote ionic availability [17], switching monopolar or multipolar controllers to provide a synergy of multiple applicators [18,19,20], and high-power generators to increase power which would help overcome impedance [21]
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