Choi Tae Won, Lee Jeong Min, Lee Dong Ho, Lee Jeong-Hoon, Yu Su Jong, Kim Yoon Jun, Yoon Jung-Hwan, Han Joon Koo
Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea.
Institute of Radiation Medicine, Seoul National University Hospital, Seoul 03080, Korea.
Korean J Radiol. 2017 Sep-Oct;18(5):799-808. doi: 10.3348/kjr.2017.18.5.799. Epub 2017 Jul 17.
To prospectively evaluate the safety and therapeutic effectiveness of dual-switching monopolar (DSM) radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma (HCC), and to retrospectively compare the results with those of single-switching monopolar (SSM) RFA in a historical control group.
This study was approved by the Institutional Review Board, with informed consent obtained from all patients. Fifty-two HCC patients who underwent DSM-RFA using a separable clustered electrode and dual-generators were prospectively enrolled. Technical parameters, complications, technical success, technical effectiveness, and local tumor progression (LTP) rates were evaluated by means of post-procedural and follow-up imaging. Thereafter, the outcome of DSM-RFA was compared with those of 249 retrospectively included HCC patients treated with SSM-RFA.
There were two major complications (3.8%, 2/52) including pleural and pericardial effusion in the DSM-RFA group. The DSM-RFA yielded a 100% technical success rate, a 98.1% technical effectiveness rate, and a 4.3% 2-year LTP rate. In a retrospective comparison between the two groups, DSM-RFA created significantly larger ablation volume (4.20 ± 2.07 cm/min vs. 3.03 ± 1.99 cm/min, < 0.01), and delivered higher energy (1.43 ± 0.37 kcal/min vs. 1.25 ± 0.50 kcal/min, < 0.01) per given time, than SSM-RFA. There was no significant difference in major procedure-related complications (3.8% vs. 4.4%) and technical effectiveness rate (98.1% vs. 96.4%) between the two groups ( = 1.00). In addition, the 2-year LTP rate of DSM-RFA and SSM-RFA were 4.3% and 10.1%, respectively ( = 0.15).
DSM-RFA using a separable clustered electrode is safe and provides high local tumor control and good preliminary clinical outcome for small HCCs, which are at least comparable to those of SSM-RFA.
前瞻性评估双切换单极（DSM）射频消融（RFA）治疗肝细胞癌（HCC）的安全性和治疗效果，并与历史对照组中采用单切换单极（SSM）RFA的结果进行回顾性比较。
本研究经机构审查委员会批准，所有患者均签署知情同意书。前瞻性纳入52例使用可分离簇状电极和双发生器接受DSM-RFA治疗的HCC患者。通过术后及随访影像学评估技术参数、并发症、技术成功率、技术有效性和局部肿瘤进展（LTP）率。此后，将DSM-RFA的结果与249例回顾性纳入的接受SSM-RFA治疗的HCC患者的结果进行比较。
DSM-RFA组有2例主要并发症（3.8%，2/52），包括胸腔和心包积液。DSM-RFA的技术成功率为100%，技术有效率为98.1%，2年LTP率为4.3%。两组回顾性比较显示，DSM-RFA在给定时间内产生的消融体积显著更大（4.20±2.07 cm³/min对3.03±1.99 cm³/min，P<0.01），且传递的能量更高（1.43±0.37 kcal/min对1.25±0.50 kcal/min，P<0.01）。两组主要手术相关并发症（3.8%对4.4%）和技术有效率（98.1%对96.4%）无显著差异（P = 1.00）。此外，DSM-RFA和SSM-RFA的2年LTP率分别为4.3%和10.1%（P = 0.15）。
使用可分离簇状电极的DSM-RFA安全，对小肝癌具有较高的局部肿瘤控制率和良好的初步临床效果，至少与SSM-RFA相当。
