Title:Balloon-Occluded Radiofrequency Ablation as Bridge to TACE in the
Treatment of Advanced HCC with Arterioportal Shunt
Volume: 15
Issue: 3
Author(s): Roberto Iezzi*, Alessandro Posa, Marco Santoro, Alessandro Tanzilli, Lucia Cerrito, Francesca Romana Ponziani, Maurizio Pompili, Antonio Grieco, Gian Ludovico Rapaccini, Antonio Gasbarrini and Riccardo Manfredi
Affiliation:
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia - U.O.C. Radiologia Diagnostica e Interventistica Generale, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, Rome 00168, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
Keywords:
HCC, RFA, ablation, chemoembolization, combined therapy, arterioportal shunt.
Abstract:
Background: Transarterial chemoembolization is the most widely used palliative treatment
for unresectable hepatocellular carcinoma; however, arterioportal shunt represents a contraindication
to this treatment.
Objective: The study aims to assess the feasibility of balloon-occluded radiofrequency ablation in the
transitory resolution of an extensive arterioportal shunt in patients with advanced hepatocellular carcinoma
as a bridge to safe and effective transarterial chemoembolization.
Methods: 12 consecutive patients advanced multinodular unilobar unresectable hepatocellular carcinoma
with a target lesion larger than 5 cm (mean diameter 7.7 ± 1.4 cm), not suitable to transarterial
chemoembolization due to extensive arterioportal shunt, were recruited. Balloon-occluded radiofrequency
ablation of the hepatic area surrounding the shunt during occlusion of the artery supplying the
shunt was performed, followed by lobar conventional chemoembolization. Intra/periprocedural
complications were evaluated. Technical success was defined by the result of radiofrequency ablation
in terms of immediate disappearance, reduction, or persistence of the shunt. Local efficacy of
chemoembolization was evaluated at 1-month computed tomography according to m-RECIST criteria.
Results: Technical success was achieved in all patients. No major complications were observed. 1-
month follow-up showed a mean necrotic diameter of 6.3 cm (range: 3.8-8.7 cm), with an acceptable
procedural result and persistence of the shunt. An overall response rate was obtained in all patients,
with 25% complete response and 75% partial response.
Conclusion: Balloon-occluded radiofrequency ablation of an arterioportal shunt in patients with advanced
hepatocellular carcinoma can temporarily reduce shunting, allowing to perform safe and therapeutically
useful chemoembolization, with satisfactory control of tumor growth.
