Adjuvant percutaneous radiofrequency ablation of feeding artery of hepatocellular carcinoma before treatment

AIM:To evaluate the feasibility and efficacy of percutaneous radiofrequency ablation(RFA) of the feeding artery of hepatocellular carcinoma(HCC) in reducing the blood-flow-induced heat-sink effect of RFA.METHODS:A total of 154 HCC patients with 177 pathologically confirmed hypervascular lesions participated in the study and were randomly assigned into two groups.Seventy-one patients with 75 HCCs(average tumor size,4.3 ± 1.1 cm) were included in group A,in which the feeding artery of HCC was identified by color Doppler flow imaging,and were ablated with multiple small overlapping RFA foci [percutaneous ablation of feeding artery(PAA)] before routine RFA treatment of the tumor.Eighty-three patients with 102 HCC(average tumor size,4.1 ± 1.0 cm) were included in group B,in which the tumors were treated routinely with RFA.Contrast-enhanced computed tomography was used as post-RFA imaging,when patients were followed-up for 1,3 and 6 mo.RESULTS:In group A,feeding arteries were blocked in 66(88%) HCC lesions,and the size of arteries decreased in nine(12%).The average number of punctures per HCC was 2.76 ± 1.12 in group A,and 3.36 ± 1.60 in group B(P = 0.01).The tumor necrosis rate at 1 mo post-RFA was 90.67%(68/75 lesions) in group A and 90.20%(92/102 lesions) in group B.HCC recur-rence rate at 6 mo post-RFA was 17.33%(13/75) in group A and 31.37%(32/102) in group B(P = 0.04).CONCLUSION:PAA blocked effectively the feeding artery of HCC.Combination of PAA and RFA significantly decreased post-RFA recurrence and provided an alternative treatment for hypervascular HCC.