Background: For large hepatocellular carcinoma (HCC) effectiveness of radiofrequency ablation (RFA) using current monopolar technique, tumbles dramatically. Recently, a single application performed with a new multipolar RFA device using simultaneously three separate electrodes was able to induce in vivo, 5 cm diameter of ablation of liver tissue. In this study the effectiveness and tolerance of multipolar RFA ablation for the treatment of large HCC were assessed.

Methods: 26 patients (median age: 72 years, [41-88 years]) with cirrhosis (Child-Pugh A/B: 22/4) and at least a main HCC larger than 4.9 cm underwent percutaneous multipolar RFA under general anaesthesia. 10 had serum alpha foeto-protein level higher than 400 ng/ml. Among the 33 tumors treated, 27 were larger or equal to 5 cm in diameter (median Æ = 5.7 cm, [5-8,5 cm]), 23 in subcapsular location, 19 in close contact with a large vessel and 12 infiltrative including 4 with sub-segmental macroscopic portal invasion. Three internally cooled coaxial bipolar electrodes were inserted under ultrasound guidance into the tumor at equidistant [1.5-3cm], in order to form isosceles triangle. For multi overlapping procedures only one electrode was removed and reinserted according to a “wheel like” translation plan. Results were assessed by computer tomography (CT) performed one month after the last RFA procedure.

Results: Complete treatments required an average of 1.1 [1-2] procedures including 2.6 [1-10] applications. The mean time of procedure was 102 ± 34 min [45-165 min]. No major complication occurred and the mean hospital stay was 2.5 ± 1.4 days [1-7 days]. CT showed complete ablation in 22/27 (81.5%) of main tumors. After a median follow up of 12 months [2-24 months], 3/22 (13.6%) of main tumors had local tumor progression. Among the 21 patients who had complete ablation of their tumor, 6 (28.6%) had distant tumor progression. Among the 26 patients, 19 (73%) remained alive, 16 (61.5%) without tumor progression. Four deaths were related to tumor progression, 1 to oesophageal varicose vein bleeding and 1 to a brain hemorrhagic stroke.

Conclusions: Multipolar RFA using simultaneously 3 separated electrodes is an effective and well tolerated treatment for large HCC in patient with cirrhosis.