Radiofrequency ablation of surface v/s intraparenchymal hepatocellular carcinoma in cirrhotic patients

Objective: To retrospectively evaluate the safety and technical efficacy of percutaneous radiofrequency ablation (RFA) of surface hepatocellular carcinoma (HCC) in comparison to intraparenchymal HCC in cirrhotic patients.

Materials and methods: Surface lesions were defined as tumours located or reaching within 1cm of liver capsule including exophytic lesions. Seventy-four surface HCC including 21 exophytic in 58 patients (surface group) and 60 intraparenchymal HCC in 54 patients (intraparenchymal group) measuring up to 4 cm in maximum extent underwent percutaneous [ultrasound (US) or computed tomography-guided (CT-guided)] RFA. The response to the treatment was assessed by contrast enhanced CT/magnetic resonance imaging (MRI) done at 1, 3, 6, 9, and 12 months of RFA and thereafter every 4-6 months. In case of features suggesting residual disease, a repeat RFA was performed. The technical success after single-session RFA, complications and disease recurrence rates were calculated and compared between two groups.

Results: Technical success achieved after first session of RFA in surface HCC was 95% (70/74) and intraparenchymal HCC was 97% (58/60). Hundred percent secondary success rate was achieved in both groups after second repeat RFA in residual lesion. No major difference in complication and local recurrence rate in both group on follow-up in surface HCC and intraparenchymal HCC. No case of needle track, peritoneal seeding, and treatment mortality was found.

Conclusions: The complication rate and efficacy of RFA for surface and exophytic HCC's were comparable to that of intraparenchymal HCC. Hence surface and exophytic lesions should not be considered a contraindication for RFA in cirrhotic patients.