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ARTICLE IN PRESS

The Egyptian Journal of Radiology and Nuclear Medicine (2014) xxx, xxx–xxx

Egyptian Society of Radiology and Nuclear Medicine

The Egyptian Journal of Radiology and Nuclear Medicine
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ORIGINAL ARTICLE

Role of percutaneous ultrasonographic guided
radiofrequency ablation in the management
of hepatocellular carcinoma
Mohamed Ahmed Youssef *, Faten Mohamed Salem, Khaled Abdelwahab Abudewan,
Enas Mohamed Korayam, Hazem Metwally Mohamed Omar
Radiodiagnosis Department, Faculty of Medicine, Tanta University, Tanta, Egypt
Received 8 November 2013; accepted 28 January 2014
Available online xxxx

KEYWORDS
Radiofrequency ablation;
HCC;
MDCT

Abstract Purpose: To evaluate the effectiveness of percutaneous ultrasonographic guided
radiofrequency thermal ablation in the management of hepatocellular carcinoma.
Patients and methods: This study included 100 patients presented with HCC showed 110 lesions, 91
lesions in the right lobe and 19 lesions in the left lobe. 86 were males (86%) and 14 were females
(14%). All patients were subjected to laboratory investigations and imaging assessment including
CT chest, bone scan, abdominal US and Triphasic Multislice Computed Tomography (MSCT) of
the abdomen. The Radio Frequency Ablation (RFA) systems used were Radiofrequency Interstitial
Thermal Ablation (RITA) System and RF 3000 monopolar system.
Results: Good ablation was achieved in 92 of 100 (92%) patients treated by RFA after the first session,
incomplete necrosis found in 8 of 100 patients (8%). Local recurrence after RFA treatment occurred in 36
of 100 patients (36%). Local recurrence occurred after one month in one of 36 patients (2.8%), after
3 months in 24 of 36 patients (66.7%), after 6 months in 8 of 36 patients (22.2%), after 9 months in 2
of 36 patients (5.5%) and after 12 months in 1 of 36 patients (2.8%). At the end of the first year, the survival
of the patients was (97%), at the end of the second year, the survival of the patients was (71.0%).
Conclusion: Radiofrequency thermal ablation is a simple, effective and less expensive technique with a
low morbidity compared with surgical treatment. Radiofrequency thermal ablation can produce significant long-term survival rates and excellent local control for cirrhotic patients with early stage, unresectable
HCC.
Ó 2014 Production and hosting by Elsevier B.V. on behalf of Egyptian Society of Radiology and Nuclear
Medicine.

* Address: 72 Elnady Street, Tanta, Gharbeya 31111, Egypt. Tel.: +20 1227446621.
E-mail address: Youssef6838@yahoo.com (M.A. Youssef).
Peer review under responsibility of Egyptian Society of Radiology and Nuclear Medicine.

Production and hosting by Elsevier
0378-603X Ó 2014 Production and hosting by Elsevier B.V. on behalf of Egyptian Society of Radiology and Nuclear Medicine.
http://dx.doi.org/10.1016/j.ejrnm.2014.01.012
Please cite this article in press as: Youssef MA et al., Role of percutaneous ultrasonographic guided radiofrequency ablation in the management of
hepatocellular carcinoma, Egypt J Radiol Nucl Med (2014), http://dx.doi.org/10.1016/j.ejrnm.2014.01.012

Germany) at a rate of 3 ml/s. 86 males (86%). Radio Frequency Ablation (RFA) systems used: A. 100 patients had HCC showed 110 lesions.2. and various thermal ablation therapies such as cryotherapy. with a mean age of 57.000 cases per year) and the third most frequent cause of cancer-related deaths (1). Laboratory investigations Imaging assessment: The aim of pre RFA radiological assessment was to evaluate intrahepatic disease and to exclude extrahepatic extension. advanced tumors. Berlin.org/10.doi. effective tumor ablation and preservation of maximal normal liver parenchyma (5). 91 lesions in the right lobe and 19 lesions in the left lobe included in this study. Population Between March 2011 and April 2013. This system allows the ablation of lesions that are 5 cm in diameter. 60.01. respectively. 4. RITA Medical System) with a power of up to 150 W and 9 electrode prongs. Introduction Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world (564. The main advantages of RFA include low morbidity and mortality rates. High resolution CT chest: Preprocedural CT chest was routinely done. Pre-RFA Procedure Assessment Thorough history taking.A.. Role of percutaneous ultrasonographic guided radiofrequency ablation in the management of hepatocellular carcinoma. Schering. 5-cm thermal ablation catheter which is 14 or 15G and 12. Written informed consent from the patients was obtained prior to each examination.1. (Natick. 2.ejrnm. 2.012 . multiplicity and location of the hepatocellular carcinomas were assessed with Couinaud nomenclature as well as that the disease confined to the liver. Surgical resection is considered to be potentially curative therapy. and 14 females (14%). diffuse infiltrative type HCC. multiplicity.2. However. The study was approved by the ethics committee of our institution. 2. B. It contains one electrode in the center and 4 prongs having thermocouples at the tips and a monitor that displays tissue temperature and impedance around the tip of the needles.3. 15 cm long insulated cannula with 1 cm shaft markers and echogenic tip that help to guide insertion under ultrasound guidance. It induces temperature changes by using high-frequency alternating current applied via electrodes placed within the tissue to generate areas of coagulative necrosis and tissue desiccation. Germany). only about 20% of HCC patients are resectable. location and echopattern of the hepatocellular carcinomas were assessed with Couinaud nomenclature as well as confirming the patency of portal and hepatic veins. tumor location precluding complete resection. microwave coagulation and radiofrequency ablation (3.ARTICLE IN PRESS 2 1. Radiofrequency ablations can be applied percutaneously. portal/venous and equilibrium phases. Erlangen.1016/j.4). RFA seems to be the most effective treatment among other locoregional therapies. Their age ranged from 35 to 73 years. Radiofrequency ablation (RFA). Triphasic CT examination: Triphasic Multislice Computed Tomography (MSCT) study of the abdomen was performed on a spiral CT scanner (Somatom plus 2. 4. For irresectable tumors. Siemens. USA). Menufya University and planned to be treated with RFA.45 years. Clinical examination. 1.1. severe coagulation disorder as prothrombin concentration less than 50% and platelet count less than 70/000 cmm3 and uncountable ascites. laparoscopically. 4. formerly Radiotherapeutics): Ablation was done by 3000 generator with a power of up to 200 W and the LeVeen electrode is a 15 gauge. Ablation was done by 1500 generator (Starburst XL. The patients referred to the Radiodiagnosis Department. Egypt J Radiol Nucl Med (2014). LN enlargement and ascites. II. Siemens Medical Systems. 4. 1. However. either local tumor recurrence or new tumor formation. The size. extra hepatic metastases. It Please cite this article in press as: Youssef MA et al. Abdominal US with color Doppler study: Using electronically focused curvilinear transducers ranging in frequency from 2. remains a significant problem (6). to arterial. Different locoregional therapies have been developed for irresectable liver tumors with an attempt to achieve local tumor control. http://dx. 15. Radiofrequency Interstitial Thermal Ablation (RITA) System: 2. These include transarterial chemoembolization (TACE). early tumor recurrence within one year.0 MHz combined with a color Doppler system (Sonoline Sienna.1. Youssef et al. Tanta University and National Liver Institute. USA. and 180 s after intravenous administration of 100 ml of contrast medium (Ultravist 370. All patients initially underwent a baseline pre-contrast scan. percutaneous ethanol injection (PEI). the remainders are irresectable because of multifocal tumors. vascular or bile duct invasion. Aim of the work The aim of this study was to evaluate the effectiveness of percutaneous ultrasonographic guided radiofrequency thermal ablation in the management of HCC.’’ is a recently developed thermoablative technique. also known as ‘‘radiofrequency thermal ablation. 3. or 25 cm in length. Methods I. or at open surgery (7). RF 3000 monopolar system produced by Boston Scientific Corp. Patients and methods M.2014. without evidence of vascular invasion or extra-hepatic metastases or biliary dilatation. despite the high complete necrosis rate of RFA. MA. or poor hepatic functional reserve (2). Exclusion criteria were based on patients with eligibility for surgical resection. The size. lesion more than 5 cm or more than 3 lesions.5 to 5. interstitial laser therapy. followed by three scans performed at 20. bile duct invasion.

) administrated intravenously.ARTICLE IN PRESS Role of percutaneous ultrasonographic guided radiofrequency ablation in the management of hepatocellular carcinoma contains 12 solid.M. Prophylactic antibiotics continued by 1 g Cefoperazone (Cefobid. the coagulation of the needle track is performed (track ablation) at temperature above 75 °C with the aim of preventing any tumor cell dissemination. Pfizer) every 12 h for two doses administrated intravenously.  Hepatic tumor markers: alpha fetoprotein. the patient referred to the ward for overnight observation of vital data and signs of postablation 3 syndrome. The patients were subjected to RFA under light general intravenous anesthesia consisting of a propofol infusion (deprivane. Statistical analysis Data were collected. antiseptics. After verifying the positioning of the needle electrode. we obtain AFP levels every 1 month.doi. At the end of the procedure.  Coagulation profile: prothrombin time. IV fluid medications. This is established at the beginning of the procedure with the goal of destroying the visible tumor mass plus 0. Supportive treatment was conducted in some cases not suitable of RFA or TACE.05 to 1-cm safety margin of ablation all around. their diameter is 5 cm and the device assumes an umbrella-shaped array design to help create a complete. Postprocedural pain management started on need basis by 2 g Paracetamol HCl (Perfalgan. III. are placed on the patient’s thighs and properly connected to the generator. the services of general anesthesia. The grounding pads. Post-procedural work-up After the procedure. No contrast enhancement was detected within or around the tumor.) every 8 h administrated orally for 7 days. spherical thermal lesion. the area of tissue ablation is monitored by US to measure the zone of increased echogenicity corresponding to the coagulation of the tissues produced by the resulting nitrogen gas microbubbles. amount of electrode array deployment from the trocar. In local or distant recurrence. http://dx. The system was tested to be sure working.ejrnm. Local recurrence: Defined as tumor nodules that emerged in the same liver segment as that of the treated tumor. The advantages of the propofol are the deep level of anesthesia that can be obtained and the short duration of action. the patients were retreated with RFA treatment. If patient still in pain. 3. AST. C.5 ug/kg). Also transarterial chemoembolization (TACE) was done in some patients not fit for RFA treatment or multiplicity developed. curved hook electrodes that are deployed in situ perpendicular to the axis of the probe. Thereafter. Please cite this article in press as: Youssef MA et al. Image analysis Adequate ablation: Defined as the presence of a well-defined area of non-enhancing tissue including the treated tumor on images obtained in both the arterial and portal phases of enhanced CT images was considered to indicate complete necrosis. When these are fully extended. Procedural work-up The Star Burst XL needle electrode was introduced into the liver through the skin incision and advanced to the target area of tumor under US guidance. B.S. Egypt J Radiol Nucl Med (2014). Follow-up performed 4 weeks postprocedural included: 1. dynamic CT scan was performed every 1 month for 3 months. After retracting the hooks.01.org/10. and the duration of the effective time of the ablation (time at target temperature) depend on the desired volume of ablation. verified. Pre-procedural work-up The procedure was done in a special sterilized unit containing the ultrasound machine. Additionally. B. Radiofrequency Ablation Technique A. SD = Standard Deviation. 3–6 mg/kg/h) and fentanyl citrate IV injection (fentanyl. ALP. The ablation zone was beyond the tumor borders.  Serum protein profile: serum albumin and total protein.012 .  Complete blood count  Renal function: blood urea and creatinine. The data were then analyzed statistically using SPSS statistical package version 12. Most of our patients were treated under local anesthesia and sedation. and the patient is placed in either the supine or the left lateral decubitus position depending on the site of the tumor and the planned needle track. B. Skin was pricked with a small sterile lancet. Laboratory investigations  Liver function status: ALT. 4. Local anesthesia was performed from the entry side on the skin to the liver capsule along the needle track with 10 ml of 2% xylocaine. the radiofrequency system. and a mobile sterile table (for sterile patients’ and doctors’ gowns. antibiotics continued by 500 mg Cephadroxil monohydrate (Duricef. 50 mg Pethidine administrated intramuscularly. Also TACE was done in some patients not fit for RFA treatment or multiplicity developed. 1–2..S. Distant recurrence: Defined as the appearance of new tumors in a different hepatic segment from that of the treated tumor. then every 3 months to detect any residual or recurrence in the ablated tumor and to monitor for the development of new hepatic or extrahepatic disease. The margin of the ablation zone was well-defined and smooth. To treat larger tumors. retractable. If there were local or distant recurrence. predictable. revised. The patient rescanned with ultrasound for 2 h after treatment to detect any bleeding in the liver or the peritoneal cavity. a ‘‘cool down cycle’’ is automatically performed. and then edited on personal computer. the right upper abdominal region is adequately sterilized. the patients were retreated with RFA treatment. multiple ablations were needed to be overlapped to build a composite thermal lesion with sufficient size to kill the entire tumor and to provide 1 cm tumor-free margin. 2. and international normalized ratio (INR).M. the multiple arrays were deployed and the needle electrode was connected to the RF generator. when the generator runs off. and gauze). Role of percutaneous ultrasonographic guided radiofrequency ablation in the management of hepatocellular carcinoma. Radiological investigations Dynamic CT scan was done one month after completion of the RFA therapy and several possibilities could be detected. The patient was prepared and draped in the usual sterile manner. Maximum power output of the RF generator. representing the dispersive electrode. During treatment. fractional and total bilirubin. syringes. The free hand technique was used with the needle electrode parallel to the plane of the US probe.1016/j. If there was no evidence of residual tumor. The following tests were done: X = Mean Median.2014.

X2 = Chi-Square Test. Therefore. http://dx. or high-intensity focused ultrasound) or freezing (cryotherapy). Youssef et al. All patients were diagnosed to have HCC and were candidate for radiofrequency ablation. Egypt J Radiol Nucl Med (2014). so the mean survival of ChildPugh Class A patients was 21.414 m for solitary tumors and 19. and 14 females (14%) with male and female ratio of 6.. the use of percutaneous ablative therapies such as radiofrequency (RF) ablation to treat primary and secondary liver tumors has increased as the underlying technology has improved in its ability to achieve adequate volumes of tumor necrosis.01. In recent years.2 ± 6. Twenty of 27 patients (74%) developed mild Rt sided pleural effusion due to ablation of sub-diaphragmatic tumor. There were 110 lesions. It is the fifth most common cancer in the world and the third most common cause of cancer-related deaths (8).560 m for tumors less than or equal to 3 cm.20 12.000. Discussion Hepatocellular carcinoma (HCC) is a major health problem worldwide.2014. the tumor number has no significant correlation with the survival. Number of patients Number of lesions No. whereas percutaneous ablation is usually reserved to patients who are not candidate to surgery owing to impaired liver function or co-morbidity. but the lack of liver donors represents a major limitation. or percutaneous ablation. So. % No. Figs. In our study.001* * P < 0. two of 27 patients (8%) developed mild peritoneal hemorrhage. surgical resection.012 .10 100. Role of percutaneous ultrasonographic guided radiofrequency ablation in the management of hepatocellular carcinoma. one of them was treated by external biliary drainage and the other was treated by biliary stenting as shown in Table 4. 6. with an estimated incidence ranging between 500. 20.8 m. % 84 11 5 100 84 11 5 100. Results This study included 100 patients.4 ± 5. So.45 years. The survival of the patients in relation to tumor size was 22 ± 4.399 and for Child-Pugh Class C patients was 12 ± 0.6 ± 5. surgical resection. 91 lesions in the right lobe and 19 lesions in the left lobe as shown in Tables 1 and 2.1–4 cm. Each of these techniques relies on controlled energy delivery to minimize Please cite this article in press as: Youssef MA et al. Nowadays.195 for multiple tumors.7 ± 5.2 100 Right lobe Left lobe Bilobar Total Table 3 Number of patients Number of lesions No. or who refuse surgery (10).org/10. for Child-Pugh Class B patients was 20.000 new cases annually.85 for tumors 4.29. 15.ejrnm.05 was considered significant. is considered the first-choice treatment for patients with early stage HCC. Their age ranged from 35 years to 73 years.940 <0. Distribution of HCC focal lesions among hepatic 5. Hepatocellular carcinoma incidence is increasing worldwide due to dissemination of hepatitis B and C virus infection. % 90 10 100 90.48 for tumors 3.14:1.A. Liver transplantation is considered the best option. opening good perspectives to radical treatment by means of liver transplantation. Table 2 lobes. The survival of the patients in relation to tumor number was 20. as it allows eliminating both tumor and cirrhosis at the same time.00 20 2 3 2 Patients with cirrhosis are the highest at risk of developing HCC and should undergo surveillance programmes to detect the tumor at an early. the survival of the patients depends on the severity of the liver cirrhosis. RFA needle N % LeVeen needle 4 cm (Boston scientific) Star burst XL needle 5 cm (Rita system) Star burst XL needle 7 cm (Rita system) Total Chi-Square X2 P-value 67 28 5 100 67 28 5 100 58. A (P) value of less than 0.000 and 1. In our study.5 ± 5. microwave ablation. the tumor size has a significant correlation with the survival of the patients as shown in Table 6. Twenty-seven of 100 patients (27%) developed post RFA complications. the time and management local and distant recurrence after RFA treatment occurred in 36 of 100 patients (36%) as shown in Table 5 .00. 69 of 100 patients (69%) were treated by Star burst XL needle 5 CM (RITA system). HCC is diagnosed at an early stage with increasing frequency. Showing complications after RFA in 100 HCC Complication N % Post RFA complications RT sided pleural effusion Peritoneal hemorrhage Liver abscess Biliary stricture 27 20 2 3 2 27. In our study.1–5 cm.00 100. % No. 86 males (86%).00 90 20 110 81. laser ablation. 24 of 100 (24%) were treated by LeVeen needle 4CM (Boston scientific system) and seven of 100 patients (7%) were treated by Star burst XL needle 7 CM (RITA system) as shown in Table 3.ARTICLE IN PRESS 4 M.00 RFA needle used in 100 HCC patients. T-test for independent samples.00 10. 3 of 27 patients (11%) developed liver abscess and 2 of 27 patients (7%) developed post RFA treatment biliary stricture.doi.8 ± 5. offering a 5year-survival rate of over 50%.70 9. with a median age of 57.8 18. Table 4 patients.1016/j. In situ thermal destruction of liver tumors uses techniques that destroy tumor tissue through heating (RF ablation. asymptomatic stage (9).00 86 14 10 110 78. 1–3.05. Table 1 Single Two Total Number of HCC lesions in 100 patients.

In our study.org/10. effective tumor ablation and preservation of maximal normal liver parenchyma (12). Please cite this article in press as: Youssef MA et al. either as solitary mass or as multiple nodules. while 10 of 100 patients (10%) had two focal lesions.78 collateral damage to normal hepatic parenchyma and other surrounding structures (11). (A–C) Triphasic CT scan revealed faintly enhanced right lobe focal lesion in the arterial phase and washout in the portovenous and delayed phases. 2004 (14) agree that in patients with typical radiological features of HCC in combination with a diagnostic level of serum AFP.56 66. Patients with one to three tumor nodules (each less than 3 cm in diameter) located in the periphery of the liver are considered (B) Pre-ablation (D) One month post-ablation (G) 6-monthpost-ablation 5 (E) (H) (C) (F) (I) Fig. http://dx.doi. Percutaneous approach is the least invasive route for RFA. presented with right lobe HCC focal lesion measuring about 5 cm in diameter (primary presentation).1016/j.22 5. This goes in agreement with Rosen and Nagorney. 1997 (13) who stated that HCC occurs most frequently in the right hepatic lobe. For irresectable tumors. to only one of 100 patients (1%). Poon et al. A single session of RFA was done. N % Time of recurrence 1 Month 3 Months 6 Months 9 Months 12 Months 1 24 8 2 1 2.67 2. Radiofrequency ablation (RFA) is considered a promising alternative to surgery. Role of percutaneous ultrasonographic guided radiofrequency ablation in the management of hepatocellular carcinoma. RFA was used to treat 110 discrete HCC foal lesions in 100 patients. In our study.78 Management RFA TACE Alcohol 11 24 1 30.78 66.56 2. Egypt J Radiol Nucl Med (2014).01. The main advantages of RFA include low morbidity (A) and mortality rates. 11 of 100 patients (14%) had left liver lobe focal lesions. US guided liver biopsy was performed to confirm the diagnosis due to atypical vascular profile on triphasic CT scan and alpha-fetoprotein level was less than 200 ng/ml.. (D and F) Post RFA triphasic CT scan obtained one month later revealed complete necrosis with no residual enhancing tumor.67 22.2014. (G–I) Follow-up triphasic CT scan obtained 6 months later revealed complete necrosis with no local or distant recurrence obtained.ejrnm. 1 Male patient 50 year old of Child-Pugh calss A. It is noted that 90 of 100 (90%) had single focal lesion.ARTICLE IN PRESS Role of percutaneous ultrasonographic guided radiofrequency ablation in the management of hepatocellular carcinoma Table 5 The time and management of local and distant recurrence in 100 HCC patients. a needle biopsy is probably not necessary before RFA. 84 of 100 patients (84%) had right liver lobe HCC focal lesions.012 . RFA seems to be the most effective treatment among other loco-regional therapies. and 5 of 100 patients had both right and left lobe HCC focal lesions.

The most reported side effects of post ablation therapy were pain. In 3 of 8 patients (37. Levragi et al. Role of percutaneous ultrasonographic guided radiofrequency ablation in the management of hepatocellular carcinoma. while the pleural effusions are more prominent while attempting approaches to tumors located high along the dome of the diaphragm.doi. 3 of 27 patients (11%) developed liver abscess and 2 of 27 patients (7%) developed post RFA treatment biliary stricture. presented with LEFT lobe (III) HCC measuring about 2 cm in diameter. In our study.2014.1016/j.7%. 2002 (17) who reported that 93% of HCC patients in his study experienced post-ablation right hypochondrial pain.012 . During the ablation process.org/10. all of the RFA procedures were done through percutaneous approach under ultrasonographic guidance.ejrnm. Triphasic CT scan was done 1 month after RFA and the lesion was completely ablated (A–C).5%) the focal lesion was near a hepatic vein (heat sink phenomenon). and new HCCs developed elsewhere in the liver segments. computed tomography (CT) or magnetic resonance imaging guidance. 2 Male patient 50 years old of Child-Pugh class A. In 7 of 8 patients (87. and nausea. Please cite this article in press as: Youssef MA et al. one of 27 patients (4%) developed mild peritoneal hemorrhage. there were no fatal complications related to RFA treatment.2% of cases (16). second session was done and complete ablation after the second session was achieved. In our study. technical success (based on the absence of residual or recurrent tumor at follow-up spiral triphasic CT) was achieved in 92 of 100 (92%) patients treated by RFA after the first session.. This agrees with Mulier et al. The former was called local tumor progression (LTP) whereas the latter called intrahepatic distant recurrence (IDR) based on standardization of terminology and reporting criteria by the international working group of image-guided tumor ablation (23).5%) with incomplete ablation was treated by TACE as it was near a hepatic vein (heat sink phenomenon). 90% and 96% respectively and it was (99%) after the second session. The patient was followed up for 12 months with an evidence of local peritumoral recurrence could be detected at 6 month follow-up that was managed by TACE with hyperdense lipidol retention and no contrast enhancement at any phase indicates adequate ablation (D–F). one of them was treated by external biliary drainage and the other was treated by biliary stenting. In our work. (21) and Curley et al.ARTICLE IN PRESS 6 M. New HCCs developed after RFA were classified into recurrence of HCC in the same subsegment of the liver that previously was successfully ablated by RFA. This is in agreement with Livragi et al. Nearly all the patients experienced postablation right hypochondrial pain that was controlled by analgesics. So success rate in achieving complete necrosis after the first session was (92%) which was in agreement with Rossi et al. Youssef et al. http://dx. Combined therapy (single session of RFA and TACE was done). (A) (B) (C) (D) (E) (F) Fig. 27 of 100 patients (27%) developed post RFA complications. Local anesthesia and conscious sedation were conducted for all patients. which was controlled by antipyretics. The main advantage of this approach is the possibility of early discharge of the patients after the ablation procedure. conscious sedation or general anesthesia is required because of pain associated with the heating of the liver capsule.01. 67 of 100 (67%) were treated by Star burst XL needle 5 CM (RITA system). for percutaneous RFA under ultrasonographic. gall bladder and major blood vessels either should not or could not be treated successfully. In our study. Pain and fever are attributed to the amount of tissue necrosis. incomplete necrosis found in 8 of 100 patients (8%). 28 of 100 (28%) were treated by LeVeen needle 4CM (Boston scientific system) and five of 100 patients (5%) were treated by Star burst XL needle 7 CM (RITA system). Ground pad skin burns were also reported in 0. In our study. (20). one of 27 patients (4%) developed peritoneal deposits. (18) and Solbiati et al. which was controlled by antiemetic. It is associated with low morbidity and mortality rates (15). Also.5%). fever and asymptomatic right sided pleural effusion.5%) incomplete ablation was due to the site of the focal lesions as they were at the dome of the liver (segment VIII) and one of 8 patients (12. One of 8 patients (12. (19) who have suggested that hepatic lesions in close proximity to hepatic capsule. nearly all experienced post-ablation pyrexia for 1–3 days.A. Egypt J Radiol Nucl Med (2014). In 4 of 8 (50%) patients incomplete ablation was due to technical problem. (22) who reported a success rate of 91. Twenty of 27 patients (74%) developed mild Rt sided pleural effusion due to ablation of Sub-diaphragmatic tumor.

(25) reported the results of RFA in 206 patients with HCC in a mean follow-up of 24 months . presented with right lobe (VII) HCC measuring about 2 cm in diameter enhanced in the arterial phase and washout in the portovenous and delayed phases (A–C). Child classification Mean survival (M) P-value * Number of the lesions Size of the lesions (cm) A B C Single Multiple 63 cm >3–4 cm >4–5 cm 21.399 and for Child-Pugh Class C patients was 12 ± 0.4 ± 5.2%). 3 Male patient 60 years old of Child-Pugh class B.8%) was treated by alcoholic injection.560 0. At the end of the second year. after 6 months in 8 of 36 patients (22.4 ± 5. http://dx.00. after 3 months in 24 of 36 patients (66. the overall survival of the patients was as following: 71 of 100 patients (71%) were alive and 29 of 100 patients (29%) were dead.2014. Radiofrequency thermal ablation can produce significant long-term survival rates and excellent local control for cirrhotic patients with early stage.the survival rates were 97% at one year .. Table 6 The mean survival (M) of 100 HCC patients in relation to Child-Pugh classification. 20. Local recurrence at RFA site is not frequent and its incidence ranges from 5.6 ± 5. the survival of the patients depends on the severity of the liver cirrhosis.5 ± 5.414 m for solitary tumors and 19. In conclusion.00 20. the tumor size has a significant correlation with the survival. In our study.8%).ARTICLE IN PRESS Role of percutaneous ultrasonographic guided radiofrequency ablation in the management of hepatocellular carcinoma (A) (B) (C) (D) (E) (F) 7 Fig.7%) were treated by TACE and one of 36 patients (2. So.29. the survival of the patients was as following: 71 of 97 patients were alive and 26 of 97 patients were dead.org/10.1016/j.5%) were treated by RFA. This is in close agreement with our results in which.195 22 ± 4. The local recurrence of RFA might be attributed to several factors including tumor characteristics and RFA techniques. This matching with our study in which most of local recurrences occurred in patients had focal lesions between 4 and 5 cm (24).5 ± 5.7% to 39%.021* 20. Local recurrence occurred after one month in one of 36 patients (2.29 0. Please cite this article in press as: Youssef MA et al. So. The patient was followed up for 6 months with an evidence of a distant recurrence could be detected at 3 month follow-up at area (IV) and a second session of RFA was done.48 for tumors 3.560 m for tumors less than or equal to 3 cm.8 ± 5. The survival of the patients in relation to tumor number was 20.01. Single session of RFA was done.6 ± 5.8%).7%).05.195 for multiple tumors. Triphasic CT scan was done 1 month after RFA and the lesion was completely ablated.85 P < 0.doi. radiofrequency thermal ablation is a simple.1–4 cm.2 ± 6.48 15.ejrnm.019* 20. Lencioni et al.1–5 cm. Then at 6 month follow-up another distant recurrence could be detected at area (III) and a session of alcohol injection was done (D–F). the tumor number has no significant correlation with the survival. 71% at 3 years and 48% at 5 years . tumor number and tumor size. for ChildPugh Class B patients was 20.424 19.414 0. unresectable HCC. The survival of the patients in relation to tumor size was 22 ± 4. 24 of 36 patients (66.Survival was significantly greater in ChildPugh class A than child B class and in those with single tumors compared with multiple tumors. At the end of our study.7 ± 5. after 9 months in 2 of 36 patients (5. Eleven of 36 patients (30. Role of percutaneous ultrasonographic guided radiofrequency ablation in the management of hepatocellular carcinoma.7 ± 5. local recurrence after RFA treatment occurred in 36 of 100 patients (36%).85 for tumors 4. Egypt J Radiol Nucl Med (2014).8 m.012 .2 ± 6. At the end of the first year.5%) and after 12 months in one of 36 patients (2. the survival of the patients was as following: 97 of 100 patients (97%) were alive and 3 of 100 patients (3%) were dead. so the mean survival of Child-Pugh Class A patients was 21. Large tumor size (more than 4 cm) is the main determining factor of local recurrence. and 15. effective and less expensive technique with a low morbidity compared with surgical treatment.8 ± 5.399 12 ± 0.

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