SIR 2024
Interventional Oncology
Deepti Sudhakar, BS (she/her/hers)
Medical Student
Saint Louis University
Financial relationships: Full list of relationships is listed on the CME information page.
Kirubahara Vaheesan, MD
Professor in the Department of Radiology
Saint Louis University School of Medicine
Disclosure information not submitted.
This study aims to evaluate the efficacy and safety of thermal ablation of diaphragmatic hepatocellular carcinoma without hydrodissection.
Materials and methods:
This was a retrospective single center study of 260 patients who received thermal ablation for HCC between February 2013 and May 2018. Due to a hospital system merger, access to the PACS system was restricted in 76 patients, so these patients were excluded. Every patient was seen pre-procedure in the clinic and viewed in tumor board to receive approval for treatment. All procedures were performed with patients under anesthesia and patients were given prophylactic antibodies. Per protocol, each patient was prescribed 12 tablets of either oxycodone or narcotics post-procedure for pain relief. Patient age ranged from 34 to 82 with a mean age of 59 ± 10 years. Follow up was conduct for each patient 6-8 weeks post-procedure either with contrast-enhanced CT imaging or contrast-enhanced MRI. Tumor size, tumor location, pre- and post-procedure blood work, local tumor progression (LTP), and survival were analyzed. This is a preliminary study of 260 patients. We plan to complete a review of 300 more cases.
Results:
36 cases of HCC located within 1 cm of the diaphragm that received thermal ablation therapy were identified. The average tumor long axis size was 2.07 ± 0.89 cm (min = 0.5 cm and max = 3.9 cm). The average tumor short axis size was 1.63 ± 0.78 cm (min = 0.4 cm and max = 3.6 cm). The average pre-treatment MELD score was 10.14 ± 3.73 (min = 6 and max = 17) and the average post-treatment MELD score was 10.77 ± 4.17 (min = 6 and max = 19). The average pre-treatment Child-Pugh score was 6.5 ± 1.42 (min = 5 and max = 11) and the average post-treatment Child-Pugh score was 6.68 ± 1.70 (min = 5 and max = 11). The year 3 survival rate was 100%. The LTP was 16.67% (n=6). None of the patients were admitted after the procedure and none of the patients had abscesses.
Conclusion:
The findings in this study support that thermal ablation without hydrodissection is a safe and effective therapy for HCCs located within 1 cm of the diaphragm.