Can targeting a liver tumor’s feeding arteries before heat ablation help control the tumor?

Details

The study aimed to establish a modified feeding artery ablation (FAA) strategy as an add-on to percutaneous radiofrequency ablation (RFA) for hypervascular hepatocellular carcinoma (HCC), and to evaluate its outcomes. In this prospective, single-arm study, 25 patients with hypervascular HCC measuring 2–5 cm in diameter were treated from June 2014 to August 2016. They underwent contrast-enhanced ultrasound (CEUS)-guided FAA before conventional RFA.

CEUS was used to evaluate the technical success of FAA and subsequent changes in tumor perfusion. CT/MRI was used at 1 month to assess technical efficacy and ablation sizes. Therapeutic outcomes—local tumor progression (LTP), overall survival (OS), and recurrence-free survival (RFS)—were evaluated using the Kaplan–Meier method. One or two target feeding arteries were visible on CEUS in 52.6% (61/116) of hypervascular HCCs measuring 2–5 cm in diameter.

The technical success rate of FAA was 100%. Of the 25 target tumors, 13/25 (52.0%) were classified as having a complete perfusion response, while 12/25 (48.0%) had a partial perfusion response. At the 1-month evaluation, the ablation volume was 41.9 ± 17.5 cm³ (range, 14.9–78.2 cm³), and the ablative safety margin was 8.2 ± 1.9 mm (range, 4–12 mm). Neither ablation volume nor safety margin differed significantly between the complete and partial perfusion-response subgroups.

Cumulative LTP rates at 1, 2, and 3 years were 0.0%, 4.2%, and 4.2%, respectively. Three-year OS was 70.3%, and three-year RFS was 59.8%. There were no treatment-related deaths. Major complications occurred in one patient (4.0%).

The researchers concluded that tailored CEUS-guided FAA, used as an add-on to conventional percutaneous RFA, can reduce tumor perfusion and provide good local control of HCC.