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

• Published in: Current radiopharmaceuticals
• Main Authors: Iezzi, Roberto, Posa, Alessandro, Santoro, Marco, Tanzilli, Alessandro, Cerrito, Lucia, Ponziani, Francesca Romana, Pompili, Maurizio, Grieco, Antonio, Rapaccini, Gian Ludovico, Gasbarrini, Antonio, Manfredi, Riccardo
• Format: Journal Article
• Language: English
• Published: United Arab Emirates 01.01.2022
• Subjects: combined therapy; HCC; chemoembolization; arterioportal shunt; RFA; ablation
• ISSN: 1874-4729
• DOI: 10.2174/1874471015666220223102426

Transarterial chemoembolization is the most widely used palliative treatment for unresectable hepatocellular carcinoma; however, arterioportal shunt represents a contraindication to this treatment. To assess the feasibility of balloon-occluded radiofrequency ablation in the transitory resolution of extensive arterioportal shunt in patients with advanced hepatocellular carcinoma as a bridge to safe and effective transarterial chemoembolization. 12 consecutive patients with 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. 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. Balloon-occluded radiofrequency ablation of arterioportal shunt in patients with advanced hepatocellular carcinoma can temporarily reduce shunting, allowing to perform a safe and therapeutically useful chemoembolization, with a satisfactory control of tumor growth.