No-Touch Multi-bipolar Radiofrequency Ablation for the Treatment of Subcapsular Hepatocellular Carcinoma ≤ 5 cm Not Puncturable via the Non-tumorous Liver Parenchyma

• Published in: Cardiovascular and interventional radiology Vol. 43; no. 2; pp. 273 - 283
• Main Authors: Petit, Arthur, Hocquelet, Arnaud, N’kontchou, Gisèle, Varin, Eloi, Sellier, Nicolas, Seror, Olivier, Sutter, Olivier
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.02.2020; Springer Nature B.V
• Subjects: Ablation; Cardiology; Cirrhosis; Clinical Investigation; Complications; Computed tomography; Females; Hemorrhage; Hepatocellular carcinoma; Imaging; Interventional Oncology; Liver; Liver cancer; Liver cirrhosis; Magnetic resonance imaging; Medicine; Medicine & Public Health; Nuclear Medicine; Parenchyma; Peritoneal seeding; Peritoneum; Radio frequency; Radiofrequency ablation; Radiology; Sepsis; Survival; Touch; Tumors; Ultrasound; Hepatocellular carcinoma; Multi-bipolar radiofrequency ablation; No-touch technique; Neoplasm seeding; Subcapsular tumor
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-019-02357-9

Purpose The percutaneous ablation of subcapsular hepatocellular carcinoma (S-HCC) may involve a risk of complications such as hemorrhage and tumor seeding, mainly linked to the direct tumor puncture often inevitable with mono-applicator ablation devices. The purpose of this study was to assess the efficacy and safety of no-touch multi-bipolar radiofrequency ablation (NTMBP-RFA) for the treatment of S-HCC ≤ 5 cm not puncturable via the non-tumorous liver parenchyma. Materials and methods Between September 2007 and December 2014, 58 consecutive patients (median age: 63 years [46–86], nine females) with 59 S-HCC ≤ 5 cm (median diameter: 25 mm [10–50 mm]), not puncturable via the non-tumorous liver parenchyma, were treated with NTMBP-RFA. Response and follow-up were assessed by CT or MRI. Complications were graded using the Cardiovascular and Interventional Radiological Society of Europe classification. Overall local tumor progression (OLTP)-free survival was assessed using the Kaplan–Meier method. A Cox proportional model evaluated the factors associated with OLTP. Signs of peritoneal or parietal tumor seeding were noted during follow-up imaging studies. Results A complete ablation was achieved in 57/58 patients (98.3%) after one ( n  = 51) or two ( n  = 6) procedures. Three patients (5.2%) experienced complications (sepsis, cirrhosis decompensation; CIRSE grade 2 or 3). After a median follow-up period of 30.5 months [1–97], no patients had tumor seeding. The 1, 2 and 3-year OLTP-free survival rates were 98%, 94% and 91%, respectively. No factors were associated with OLTP. Conclusion NTMBP-RFA is a safe and effective treatment for S-HCC not puncturable via the non-tumorous liver parenchyma.