de Baere Thierry, Deschamps Frederic, Briggs Patricio, Dromain Clarisse, Boige Valérie, Hechelhammer Lukas, Abdel-Rehim Mohamed, Aupérin Anne, Goere Diane, Elias Dominique
Department of Interventional Radiology, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Cedex, Villejuif, France.
Radiology. 2008 Sep;248(3):1056-66. doi: 10.1148/radiol.2483070222. Epub 2008 Jul 15.
To prospectively evaluate the technical feasibility, effectiveness, and complications of percutaneous radiofrequency (RF) ablation for hepatic malignancies during temporary percutaneous balloon occlusion (PBO) of a large hepatic or portal vein.
During a 4-year period, RF ablation was performed in 201 patients (106 men, 95 women; age range, 41-88 years) with 233 liver tumors. Institutional review board approval was obtained to attempt RF ablation during PBO for 18 tumors that were larger than 35 mm (mean, 43 mm +/- 7.6 [standard deviation]; range, 36-60 mm) and did not abut a portal or hepatic vein 4 mm in diameter or larger (group 1), 58 tumors 35 mm or smaller (mean, 23 mm +/- 7.3; range, 12-35 mm) that abutted a large vessel (group 2), and 20 tumors that were both larger than 35 mm (mean, 42 mm +/- 5.7; range, 38-50 mm) and abutted a large vessel (group 3). RF ablation without PBO was performed for 137 tumors 35 mm or smaller (mean, 22 mm +/- 6.8; range, 9-35 mm) and remote from large vessels (group 4). Rate of local tumor progression was estimated with the Kaplan-Meier method, and tumor progression-free rates were compared between the four groups with the log-rank test. Complications were compared by using the Fisher exact test between the four groups and between the two RF devices used.
PBO was achieved in 94 of 96 attempts (98%), including 64 of 64 hepatic veins and 30 of 32 portal branches. After a mean follow-up of 18 months +/- 9, 10 tumors in eight patients were lost to follow-up. Local tumor progression was observed in six (40%) of 15 tumors in group 1, in six (11%) of 56 tumors in group 2, in eight (40%) of 20 tumors in group 3, and in 12 (9%) of 130 tumors in group 4. Combined analysis of tumor size and the use of PBO showed that size was the only prognostic factor for tumor progression, with a hazard ratio of 4.9 (95% confidence interval: 2.4, 9.9) (P < .001). There were no differences between groups 2 and 4. Asymptomatic, transient postprocedure venous thrombosis was seen in nine of 94 RF ablations with PBO, while occlusion of one permanent portal branch induced segmental liver atrophy. There were no differences in rates of complications (5% and 6% for RF ablation with and that without PBO, respectively).
RF ablation with PBO provides tumor control for tumors smaller than 35 mm in diameter that abut vessels 4 mm or larger, equivalent to tumor control of the same-size tumors away from vessels. PBO does not seem to affect the results of RF ablation for tumors 35 mm or larger.
前瞻性评估在经皮临时球囊闭塞（PBO）大的肝静脉或门静脉期间，经皮射频（RF）消融治疗肝恶性肿瘤的技术可行性、有效性及并发症。
在4年期间，对201例患者（106例男性，95例女性；年龄范围41 - 88岁）的233个肝肿瘤进行了RF消融。经机构审查委员会批准，对18个直径大于35 mm（平均43 mm±7.6[标准差]；范围36 - 60 mm）且不紧邻直径4 mm或更大的门静脉或肝静脉的肿瘤（第1组）、58个直径35 mm或更小（平均23 mm±7.3；范围12 - 35 mm）且紧邻大血管的肿瘤（第2组）以及20个既大于35 mm（平均42 mm±5.7；范围38 - 50 mm）又紧邻大血管的肿瘤（第3组），在PBO期间尝试进行RF消融。对137个直径35 mm或更小（平均22 mm±6.8；范围9 - 35 mm）且远离大血管的肿瘤（第4组）进行了无PBO的RF消融。采用Kaplan - Meier法估计局部肿瘤进展率，并用对数秩检验比较四组的无肿瘤进展率。通过Fisher精确检验比较四组之间以及所使用的两种RF设备之间的并发症情况。
96次尝试中有94次（98%）成功实现PBO，包括64条肝静脉中的64次和32个门静脉分支中的30次。平均随访18个月±9个月后，8例患者中的10个肿瘤失访。第1组15个肿瘤中有6个（40%）出现局部肿瘤进展，第2组56个肿瘤中有6个（11%），第3组20个肿瘤中有8个（40%），第4组130个肿瘤中有12个（9%）。肿瘤大小与PBO使用情况的综合分析表明，大小是肿瘤进展的唯一预后因素，风险比为4.9（95%置信区间：2.4，9.9）（P <.001）。第2组和第4组之间无差异。在94次有PBO的RF消融中有9次出现无症状、短暂的术后静脉血栓形成，而1个永久性门静脉分支闭塞导致节段性肝萎缩。并发症发生率无差异（有PBO和无PBO的RF消融分别为5%和6%）。
对于直径小于35 mm且紧邻4 mm或更大血管的肿瘤，PBO辅助的RF消融可实现肿瘤控制，等同于对远离血管的相同大小肿瘤的控制。PBO似乎不影响直径35 mm或更大肿瘤的RF消融结果。
