Archive \ Volume.14 2023 Issue 1

Role of Interventional Radiology in Management of Hepatocellular Carcinoma: Systematic Review

Qaed Salem Alhammami^1*, Sultan Nawi Arfaj Alanazi², Sultan Mudhhi H Alanazi², Ahmed Rashed Elnoor Mohammed², Sulaiman Turki Arfaj Alanazi³, Zainab Ayesh Alruwaily⁴

¹Najran University, Najran, Saudi Arabia. ²Prince Abdulaziz Bin Musaad Hospital, Arar, Saudi Arabia. ³North Medical Tower, Arar, Saudi Arabia. ⁴Department of Nursing, College of Medicine and Applied Medical Sciences, Northern Border University, Saudi Arabia.

Abstract

The purpose of this study is to analyse and evaluate the function of interventional radiology in such instances by evaluating several elements of each procedure, such as its influence on survival rates, recurrence, tumour response, and complications. The following databases were searched: PubMed, Web of Science, Science Direct, EBSCO, and the Cochrane Library. Using Rayyan QCRI, study papers were screened by title and abstract before being subjected to a full-text evaluation. This review included 13 studies with participants of varying ages and genders; more than half were males. All included studies discussing the role of interventional radiology in hepatoma cases in diagnosis and treatment. We included Sex studies that were systematic reviews; two were randomized controlled, one was a case-control study, one was a prospective study, two were retrospective studies, and one was a pilot study. In the ablation therapy of hepatocellular carcinoma nodules, we determined that microwave ablation had greater complete ablation and lower local tumour growth than radiofrequency ablation. In large tumors (up to 6 cm), mwa is preferred, and cryoablation is preferred in recurrent disease. Because of a lesser heat-sink effect, mwa and cryoablation are preferred to RFA in perivascular disease. Chemoablation can be used in smaller lesions (<3 cm). In intermediate-stage, multifocal lesions (>3), tace, debs, and tare are to be used.

Keywords: Interventional radiology, Hepatocellular carcinoma, Radiofrequency ablation, Microwave ablation, Ultrasound-guided.

Radiofrequency ablation (RFA) and cryoablation are considered successful curative treatment options for hepatocellular carcinoma (HCC). In order to compare the two techniques, Wang et al., This research evaluated the therapeutic effectiveness of percutaneous cryoablation to RFA in cirrhotic individuals with HCC measuring 4 cm and no more than two tumours [7]. The primary technique efficacy rate, LTP, distant intrahepatic recurrence, comorbidities, overall survival, and tumor-free survival did not differ significantly between the two groups. To our knowledge, this is the biggest prospective, multicenter randomised trial comparing these two HCC therapy approaches. Another nonrandomized trial compared the results of cryoablation versus RFA for hepatic malignancies such as HCC and metastatic liver cancers [24, 25]. A meta-analysis based on these studies revealed that RFA was considerably superior to cryoablation in terms of complications and LTP [26], however it had been observed that problems following cryoablation were related to the total ablation or freeze volume [27, 28].

Luo et al., also compared the therapeutic effects of multiple ablative techniques in their systematic review and meta-analysis [16]. They discovered that the effects of MWA and CRA looked to be similar to those of RFA, however there were lower rates of LTR and greater rates of CTA in big tumours compared to RFA (P 0.05). CTA rates were lower in PEI patients (odds ratio [OR] 0.16, 95% confidence interval [CI] 0.06-0.42) and higher in PEI + RFA patients (OR 2.28, 95% CI 1.19-3.60), with an increased incidence of fever (P 0.05). LSA was associated with decreased CTA rates (OR 0.32, 95% CI 0.13-0.81) and overall survival (hazard ratio 1.47, 95% CI 1.01-2.15), as well as less comorbidities. Kazutaka and colleagues [29]. The PEI-RFA group had bigger regions of coagulated necrosis (34 29.3 cm3) than the RFA group (6.5 3.6 cm3; P 0.0001). The volume of coagulated necrosis was substantially and positively associated with the amount of ethanol injected into the tumour, but not with the energy need. As a result, when using PEI-RFA in high-risk regions, such as near arteries or other vital organs, ethanol infusion reduces RFA energy, sparing the surrounding tissues. However, according to Luo et al., Fever was observed to be more common following PEI-RFA than after RFA in one research [16]. In a Japanese research [30], however, the tumour in CRA patients was adjacent to the hollow viscera, such as the gallbladder, or an essential structure, such as the hepatic hilum, was not mentioned in the thermal ablation group. Furthermore, lesser LTR in the CRA group was recorded in the RFA/MWA group for tumours with a diameter higher than 2 cm in the same research. In terms of complications, myoglobulinemia was not reported during RFA but occurred in 3 of 33 CRA operations [31].

In the treatment of hepatocellular cancer, Paul et al., compared the effectiveness of percutaneous acetic acid (PAAI) to that of radiofrequency ablation (RFA) (HCC) [19]. They discovered that PAAI and RFA had comparable cumulative overall survival. Furthermore, the tumour response rate to PAAI was comparable to that of RFA. However, they discovered that employing PAAI required more sessions than RFA to cure HCC. Lin et al., also reported the need for further PAAI therapy sessions [32]. Paul et al.'s tumour response rate after PAAI [19]. The research was 75% complete. There are no studies on the use of PAAI only on similar-sized HCCs in the literature. A combination of TACE and PAAI yielded response rates of 100% and 95% in HCCs 5 cm [33, 34].

Peng et al., found that percutaneous MWA showed satisfactory therapeutic efficacy for local cancer control [23]. Nevertheless, the percutaneous MWA treatment was found to be inadequate in four patients. CEUS, CT, or MRI indicated that percutaneous MWA produced complete necrosis of tumors on the other 28 (87.5%) patients and thus successfully prevented LTP. Studies have shown that tumor ablation in the caudate lobe would be more affected by the heat-sink effect because of the proximity of the lobe to the hepatic veins and the IVC [35]. It is challenging to increase the ablative margin for tumors in the caudate lobe because of the complex surrounding tissues. Portal vein tumor thrombus was treated by TACE combined with sorafenib, and during follow-up, the tumor thrombus was reduced significantly. Some scholars have already reported that TACE and sorafenib could improve OS for HCC patients with tumor thrombus [36].

Schullian et al., conducted a prior case-control research to assess the safety and efficacy of stereotactic radiofrequency ablation (SRFA) for the treatment of subcardiac hepatocellular carcinoma (HCC) [20]. They discovered no statistically significant difference in terms of significant complications (p = 0.76), primary and secondary efficacy (p = 0.93 and 0.23, respectively), local recurrence (p = 0.25), OS (p = 0.28, in terms of singular HCC), and DFS (p = 0.89, in terms of singular HCC) between cases and controls. These findings are significant because they demonstrate that patients with subcardiac tumours should still be offered the operation and that the consent process for tumours located far from the heart should be identical. They also found a low complication rate, which might be attributed to higher tumour sizes and the treatment of many tumours in a single session. The surgical literature, on the other hand, reveals higher levels of postoperative morbidity ranging from 5 to 45% [37]. They treated tumours in 95.6% of instances with complete removal of tumour enhancement in the first session and 99.1% following retreatment, with a 7% local recurrence rate and no significant difference compared to the control group.

It was reported previously that hyperosmotic saline-enhanced radiofrequency and microwave ablation had the same results in treating hepatocellular carcinoma and colorectal liver metastasis [38]. These results were obtained by Radosevic et al., [18]. They also discovered that MWA produced bigger ablation zones than RFA, while having identical ablation zone morphologies (reported as a short to large diameter ratio) and a similar technical success and local tumour growth rate in liver tumours ranging in size from 1.5 to 4 cm. However, even with traditional RFA devices, local tumour progression is less than 1% in tumours under 2 cm [39, 40], and in liver tumours larger than 4 or 5 cm may result in an unacceptable incidence of local tumour progression, occasionally exceeding 60% in classical references [39, 40].

Tilborg et al. [41] discovered that biliary complications (biloma/biliary leakage, biliary blockage, and bilio-pleural fistula) were more common following peribiliary-MWA (57%) vs. peribiliary-RFA (3%), in a retrospective investigation of 774 colorectal metastases treated with MWA or RFA in 243 patients. These large disparities did not diminish with operator experience, suggesting that MWA was initially regarded as less safe than RFA due to the less predicted ablation zone shape [42].

In contrast to Radosevic et al., [18], Zhimin et al., [14] conducted a prior systematic study on the efficacy and safety of radiofrequency and microwave ablation in the treatment of HCC. In cohort studies, microwave ablation exhibited a lower rate of local tumour development than radiofrequency ablation (OR = 0.78, 95% CI 0.64-0.96, P =.02). In cohort studies, the complete ablation rate of microwave ablation was greater than that of radiofrequency ablation (OR = 1.54, 95% CI 1.05-2.25, P =.03). There was no statistically significant difference between the two groups in terms of overall survival or disease-free survival. A meta-analysis revealed no statistically significant difference in the primary problems of microwave and radiofrequency ablation.

CONCLUSION

Following a thorough assessment of the literature, we determined that in the ablation therapy of hepatocellular carcinoma nodules, microwave ablation had greater complete ablation and lower local tumour growth than radiofrequency ablation. Mwa is preferable in big tumours (up to 6 cm), while cryoablation is recommended in recurring disease. MWA and cryoablation are recommended to RFA in perivascular disease due to a lower heat-sink effect. Chemoablation can be performed on lesions as small as 3 cm. Multifocal lesions (>3), tace, debs, and tare are to be employed in the intermediate stage.

ACKNOWLEDGMENTS: Many thanks to Dr. Qaed Salem Alhammami: Consultant & Assistant Professor of Radiologist, Najran University, Saudi Arabia, for his continuous help, support and encouragement to complete this work.

CONFLICT OF INTEREST: None

FINANCIAL SUPPORT: None

ETHICS STATEMENT: None