L. Lupo, M. Stefano, P. Panzera, A. Gallerani, G. Di Palma, F. Tandoi, V. Memeo; Bari/IT

Purpose
The ablation effect of RF is increased by ischemia. Therefore arterial and/or portal flow occlusion (by TACE and/or PVE) were associated to RFA in the percutaneous treatment of large primary or secondary liver cancer. In this study we audited our experience with the combined procedures.

Material and methods
Patients and Methods Fourteen patients with primary (8 HCC, 1 CCA) on cirrhosis HBV/HCV or metastatic (5 CRC) liver cancer (Ø= 7cm, range 5-12 cm; Single: 6; Multiple: 8) underwent TACE + percutaneous PV embolization (9) or surgical ligation (5), and RFA by application of energy (180 W for 12 min) through multiple insertion of a triple cooled needle. Univariate analysis was conducted by Fischer’s test.

Results
Results No patients died from the combined procedures, but 2 abscess and 1 liver failure occurred. Total ischemia was obtained in 12/14 and complete necrosis of lesion was observed in 10/14 patients ( evaluated by CT-scan ). Five patients underwent liver resection, 4 did not required further treatment ( all HCC ), 4 CRC patients experienced rapid deterioration and 1 refusal treatment. Poor outcome was correlated to liver disease (CRC vs HCC 4/5 vs 0/9, p<0.02) to multiple vs single (4/8 vs 0/6, p<0.07), to lobar vs segmental PVE (4/8 vs 0/6, p< 0.07)

Conclusion
Conclusions RFA under selective arterial and portal flow occlusion may be a safely approach. Results are much better in primary than in CRC liver metastasis.