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Radiofrequency Ablation in the Treatment of Small Hepatocellular Carcinomas: Comparison of the Radiofrequency Effect With and Without Chemoembolization

Mikiya Kitamoto1, Masaru Imagawa1, Hiroyasu Yamada1, Chiyuki Watanabe1, Masaaki Sumioka1, Osamu Satoh1, Masaru Shimamoto1, Michiyo Kodama1, Shojiro Kimura2, Keiko Kishimoto2, Yuzo Okamoto3, Yasuhiko Fukuda3 and Kiyohiko Dohi3

1 Department of Gastroenterology, Hiroshima Prefectural Hospital, 1-5-54 Ujina-Kanda, Minami-ku, Hiroshima 734-8530, Japan.
2 Department of Radiology, Hiroshima Prefectural Hospital, Minami-ku, Hiroshima 734-8530, Japan.
3 Department of Surgery, Hiroshima Prefectural Hospital, Minami-ku, Hiroshima 734-8530, Japan.



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  		Fig. 1. —Flow diagram shows algorithm of patient treatment. Tumor markers = {alpha}-fetoprotein and des-gamma-carboxy prothrombin, chemoembolization = transcatheter arterial chemoembolization, RFA = radiofrequency ablation.

 


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  		Fig. 2A. — Representative clinical course of combination therapy in 71-year-old man with cirrhosis and hepatocellular carcinoma. Selected image from digital subtraction angiography of right hepatic artery reveals hypervascularity in liver segment VII.

 


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  		Fig. 2B. — Representative clinical course of combination therapy in 71-year-old man with cirrhosis and hepatocellular carcinoma. CT image obtained 10 days after chemoembolization shows Lipiodol (iodized oil, Nihon Schering, Osaka, Japan) accumulation in main nodule with diffuse accumulation in adjacent nontumor liver tissue. Doxorubicin–Lipiodol emulsion in doses of 35 mg was injected through right hepatic artery.

 


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  		Fig. 2C. — Representative clinical course of combination therapy in 71-year-old man with cirrhosis and hepatocellular carcinoma. CT image obtained 5 days after percutaneous radiofrequency ablation shows that lesion has been replaced by extensive area of hypoattenuation in region of Lipiodol accumulation.

 


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  		Fig. 2D. — Representative clinical course of combination therapy in 71-year-old man with cirrhosis and hepatocellular carcinoma. CT image obtained 12 months after treatment shows no sign of local recurrence.

 


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  		Fig. 3A. —76-year-old woman with cirrhosis and hepatocellular carcinoma close to large vessels in whom biliary stenosis was observed 3 months after radiofrequency ablation. Selected image from digital subtraction angiography of anterior branch of right hepatic artery angiogram reveals hypervascularity in liver segment VIII (arrowheads).

 


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  		Fig. 3B. —76-year-old woman with cirrhosis and hepatocellular carcinoma close to large vessels in whom biliary stenosis was observed 3 months after radiofrequency ablation. CT image obtained 2 weeks after chemoembolization shows Lipiodol (iodized oil, Nihon Schering, Osaka, Japan) accumulation with partial early enhancement (arrow). Doxorubicin–Lipiodol emulsion in doses of 30 mg was injected through right hepatic artery.

 


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  		Fig. 3C. —76-year-old woman with cirrhosis and hepatocellular carcinoma close to large vessels in whom biliary stenosis was observed 3 months after radiofrequency ablation. CT image obtained 4 days after percutaneous radiofrequency ablation shows that therapeutic area covers tumor.

 


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  		Fig. 3D. —76-year-old woman with cirrhosis and hepatocellular carcinoma close to large vessels in whom biliary stenosis was observed 3 months after radiofrequency ablation. MR cholangiopancreatogram obtained 5 months after treatment reveals biliary stenosis at treated site (arrow) and moderate dilatation of bile duct at right lobe.

 


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  		Fig. 3E. —76-year-old woman with cirrhosis and hepatocellular carcinoma close to large vessels in whom biliary stenosis was observed 3 months after radiofrequency ablation. CT scan obtained 24 months after treatment shows no sign of local recurrence and no change in bile duct dilatation.

 

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