Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2021; 9(7): 1580-1591
Published online Mar 6, 2021. doi: 10.12998/wjcc.v9.i7.1580
Short-term outcomes of radiofrequency ablation for hepatocellular carcinoma using cone-beam computed tomography for planning and image guidance
Xue-Song Yao, Dong Yan, Xian-Xian Jiang, Xiao Li, Hui-Ying Zeng, Huai Li
Xue-Song Yao, Dong Yan, Xiao Li, Hui-Ying Zeng, Huai Li, Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Xian-Xian Jiang, Australian Research Council Training Centre for Innovation in Biomedical Imaging Technology, University of Queensland, Brisbane 4000, Australia
Author contributions: Li H and Yao XS contributed to study concept and design; Yan D and Zeng HY contributed to performing the RFA procedure; Yao XS and Jiang XX contributed to acquisition of clinical data, statistical analysis, and data interpretation; Yao XS wrote the first draft of the manuscript; Li X wrote sections of the manuscript; Li H and Li X supervised and oversaw the study.
Institutional review board statement: The study was reviewed and approved by the [Ethics Committee of Cancer Institute and Hospital, Chinese Academy of Medical Sciences] Institutional Review Board (No. 14-049/839).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflicts of interest related to this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Huai Li, MD, Chief Doctor, Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. lihuai1956@hotmail.com
Received: September 20, 2020
Peer-review started: September 20, 2020
First decision: December 4, 2020
Revised: December 22, 2020
Accepted: January 8, 2021
Article in press: January 8, 2021
Published online: March 6, 2021
Abstract
BACKGROUND

Percutaneous radiofrequency ablation (RFA) is an effective treatment for unresectable hepatocellular carcinoma (HCC) and a minimally invasive alternative to hepatectomy for treating tumour recurrence. RFA is often performed using contrast-enhanced computed tomography (CECT) and/or ultrasonography. In recent years, angiographic systems with flat panel image detectors and advanced image reconstruction algorithms have broadened the clinical applications of cone-beam computed tomography (CBCT), including RFA. Several studies have shown the effectiveness of using CBCT for immediate treatment assessments and follow-ups.

AIM

To assess the treatment response to RFA for HCC using CBCT.

METHODS

Forty-eight patients (44 men; aged 37-89 years) with solitary HCC [median size: 3.2 (1.2-6.6) cm] underwent RFA and were followed for 25.6 (median; 13.5-35.2) mo. Image fusion of CBCT and pre-operative CECT or magnetic resonance imaging (MRI) was used for tumour segmentation and needle path and ablation zone planning. Real-time image guidance was provided by overlaying the three-dimensional image of the tumour and needle path on the fluoroscopy image. Treatment response was categorized as complete response (CR), partial response (PR), stable disease (SD), or progressive disease (PD). Disease progression, death, time to progression (TTP), and overall survival (OS) were recorded. Kaplan-Meier and Cox regression analyses were performed.

RESULTS

Initial post-RFA CECT/MRI showed 38 cases of CR (79.2%), 10 of PR (20.8%), 0 of SD, and 0 of PD, which strongly correlated with the planning estimation (42 CR, 87.5%; 6 PR, 12.5%; 0 SD; and 0 PD; accuracy: 91.7%, P < 0.01). Ten (20.8%) patients died, and disease progression occurred in 31 (35.4%, median TTP: 12.8 mo) patients, resulting in 12-, 24-, and 35-mo OS rates of 100%, 81.2%, and 72.2%, respectively, and progression-free survival (PFS) rates of 54.2%, 37.1%, and 37.1%, respectively. The median dose-area product of the procedures was 79.05 Gy*cm2 (range 40.95-146.24 Gy*cm2), and the median effective dose was 10.27 mSv (range 5.32-19.01 mSv). Tumour size < 2 cm (P = 0.008) was a significant factor for OS, while age (P = 0.001), tumour size < 2 cm (P < 0.001), tumour stage (P = 0.010), and initial treatment response (P = 0.003) were significant factors for PFS.

CONCLUSION

Reliable RFA treatment planning and satisfactory outcomes can be achieved with CBCT.

Keywords: Hepatocellular carcinoma, Radiofrequency ablation, Cone-beam computed tomography, Survival, Prognosis, Effectiveness

Core Tip: This is a prospective study to assess the treatment response to radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) using cone-beam computed tomography (CBCT) for treatment planning and image guidance. Satisfactory 1-, 2-, and 3-year overall survival and disease progression outcomes were achieved in patients with solitary HCC when treated by RFA under CBCT. Image fusion of pre-operative CT/magnetic resonance imaging with CBCT allows precise RFA treatment planning and real-time image guidance. The initial treatment response strongly correlates with RFA planning and is an independent predictor of short-term outcomes, implying the necessity of reliable treatment planning.