Preliminary experience with direct percutaneous arterial embolisation combined with radiofrequency ablation for hypervascular HCC

Abstract

Objective: The purpose of this study was to evaluate the outcomes of a novel technique consisting of ultrasound-guided percutaneous arterial embolisation (PAE) of the tumour-feeding artery before radiofrequency ablation (RFA) for hypervascular hepatocellular carcinoma (HCC). Methods: Twenty-three HCC patients with hypervascular tumours who were non-TACE candidates were enrolled in the study. The mean size of the tumours was 4.6 ± 1.2 cm (3.2–6.0 cm). PAE was performed using 20-gauge catheter needles under greyscale and colour ultrasound guidance. Regular follow-up was performed to evaluate the outcomes and safety of this novel method. Results: Post-PAE colour Doppler ultrasound revealed an immediate embolising effect in 29 feeding arteries, including 21 arteries that became invisible (72.4%) and 8 arteries that exhibited reduced flow velocity (27.6%). Based on the one-month enhanced CT/MRI, complete necrosis was achieved in 24 of 25 tumours (96.0%). The mean follow-up period was 42.7 ± 9.8 months. Local tumour recurrence was observed in 3 tumours (12.0%), and new intrahepatic tumours developed in 9 patients (39.1%). The probabilities of overall survival at 1, 3, 5 and 10 years were 77.3%, 40.0%, 25.0% and 18.8%, respectively. No major complications occurred in this group. Conclusions: The PAE method could help effectively to reduce or inhibit the blood supply of HCC. RFA followed by PAE treatment achieved 25.0% 5-year survival with no major complications. As a minimally invasive approach, PAE may provide a novel local therapy for hypervascular HCC patients who are non-TACE candidates.