Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2021; 9(7): 1580-1591
Published online Mar 6, 2021. doi: 10.12998/wjcc.v9.i7.1580
Short-term outcomes of radiofrequency ablation for hepatocellular carcinoma using cone-beam computed tomography for planning and image guidance
Xue-Song Yao, Dong Yan, Xian-Xian Jiang, Xiao Li, Hui-Ying Zeng, Huai Li
Xue-Song Yao, Dong Yan, Xiao Li, Hui-Ying Zeng, Huai Li, Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Xian-Xian Jiang, Australian Research Council Training Centre for Innovation in Biomedical Imaging Technology, University of Queensland, Brisbane 4000, Australia
Author contributions: Li H and Yao XS contributed to study concept and design; Yan D and Zeng HY contributed to performing the RFA procedure; Yao XS and Jiang XX contributed to acquisition of clinical data, statistical analysis, and data interpretation; Yao XS wrote the first draft of the manuscript; Li X wrote sections of the manuscript; Li H and Li X supervised and oversaw the study.
Institutional review board statement: The study was reviewed and approved by the [Ethics Committee of Cancer Institute and Hospital, Chinese Academy of Medical Sciences] Institutional Review Board (No. 14-049/839).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflicts of interest related to this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Huai Li, MD, Chief Doctor, Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China.
Received: September 20, 2020
Peer-review started: September 20, 2020
First decision: December 4, 2020
Revised: December 22, 2020
Accepted: January 8, 2021
Article in press: January 8, 2021
Published online: March 6, 2021
Research background

Percutaneous radiofrequency ablation (RFA) is an effective treatment for unresectable hepatocellular carcinoma (HCC). In recent years, angiographic systems with flat panel image detectors can use cone-beam computed tomography (CBCT) to guide RFA and show great effectiveness.

Research motivation

To assess the short-term response, radiation dose, and time to progression associated with CBCT guided RFA in HCC patients.

Research objectives

To assess radiation dose during operation, short-term response, and time to progression in HCC patients undergoing CBCT guided RFA.

Research methods

Our prospective research studied HCC patients who underwent CBCT guided RFA. The basic status of the patients, including age, sex, Barcelona Clinic Liver Cancer stage, Child-Pugh score, tumour size and tumour adjacency to major vessels, the diaphragm, or other organs, was recorded. The radiation dose during RFA, short-term response, and time to progression were recorded during the follow-up.

Research results

There were 48 patients (44 males and 4 females) who underwent RFA guided by CBCT without major complications. The median tumour size was 3.2 cm (range 1.2-6.6 cm). The median dose area product of the procedures was 79.05 Gy*cm2 (range 40.95-146.24 Gy*cm2), and the median effective dose was 10.27 mSv (range 5.32-19.01 mSv). The post-RFA initial clinical assessment using contract-enhanced CT or magnetic resonance imaging showed 38 (79.2%) cases of complete response, 10 (20.8%) of partial response, 0 of stable disease, and 0 of progressive disease. The median time to progress was 12.8 mo.

Research conclusions

CBCT guided RFA is a reliable treatment for HCC patients. It could enhance tumour visualization and contribute to satisfactory treatment responses. This is particularly beneficial for interventional oncologists who have limited access to dedicated CT and/or ultrasound units for therapeutic purposes.

Research perspectives

The current study did not use contrast-enhanced CBCT to conduct the post-RFA immediate response assessment, and further investigations, particularly those incorporating intravenous contrast injection, might be clinically meaningful.