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The role of ultrasound-guided percutaneous embolization of feeding vessel combined with radiofrequency ablation in treating hepatocellular carcinoma
M. Chen, H. Zhang, W. Yang, Y. B. Hou, L. Huo, K. Yan, J. Y. Wu, L. Shen;
the School of Oncology, Peking University, Beijing, CHINA.
Background: to investigate the feasibility and efficiency of ultrasound-guided percutaneous feeding arterial embolization (PFAE) combined with radiofrequency ablation (RFA) for HCC, which were not candidate for TACE or still had rich supply after TACE. Methods: A total of 27 HCC patients with 31 feeding arterials underwent PFAE before RFA and 25 of them achieved success (PFAE group). Among them, infusion of chemotherapy drug and iodized oil into feeding vessel were conducted in 14 patients and RFA was performed 5-14 days later (PFAE-A group). In the remaining 11 patients, only iodized oil was injected into the feeding vessel and contrast enhanced ultrasound (CEUS) guided RFA was performed immediately (PFAE-B group). Another 23 HCC patients with rich supply underwent RFA without PFAE in our early RFA practice and served as control group. There was no significant difference in the clinical date between these two groups. PFAE was conducted as follows: inserted a 20-22 G needle into feeding arterial under ultrasound monitoring, and then injected embolization agent after identifying exact puncturing the feeding arterial. Results: 29 arterials (93.5%) in 25 cases achieved PFAE success. Color US immediately after PFAE showed effective embolization of 28 feeding arterials (96.6%), included arterial flow disappearing (20 vessels) and arterial flow decreasing (8 vessels). Grey US demonstrated echogenicity increased in 88% (22/25) of tumors. In PFAE-A group, tumor size decreased in 50% (7/14) of cases and embolized arterial flow appeared again in 3 cases. In PFAE-B group, >50% area of perfusion defect was found in 8 cases by CEUS immediately after PFAE. Based on imaging follow-up, the tumor necrosis rate of PFAE group was 96% and 88% at 1 month and 1 year respectively, which was significantly higher than those of control group (65.2% at 1 month, P=0.009; 56.5% at 1 year, P=0.014). In PFAE-A group, small amount of Intraperitoneal hemorrhage occurred in 2 cases and blood cell slightly decreased in.5 cases. There was no major complication in all groups. Conclusions: PFAE could reduce or obstruct feeding arterial for HCC and then increase the tumor necrosis rate after RFA.
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