Radiofrequency ablation for intrahepatic hepatocellular carcinoma and percutaneous ethanol injection for portal vein tumor thrombus: safety and feasibility.

To assess the viability and safety of radiofrequency ablation (RFA) for intrahepatic tumors in hepatocellular carcinoma (HCC) treatment, as well as percutaneous ethanol injection (PEI) for portal vein tumor thrombus (PVTT). From January 2010 to December 2020, a total of 25 HCC patients who underwent RFA for intrahepatic tumor combined with PEI for PVTT were enrolled. Treatment response (assessed using modified Response Evaluation Criteria in Solid Tumors [mRECIST] based on contrast-enhanced computed tomography [CECT] or contrast-enhanced ultrasound [CEUS]), overall survival (OS), progression-free survival (PFS), and safety profile were evaluated. Univariate and multivariate analyses were performed to identify the prognostic factors in predicting the OS and PFS. The overall response rate was 88%, including 12 (48%) patients achieving complete response (CR) and 10 (40%) patients achieving partial response (PR). Progressive disease (PD) was observed in 3 (12%) patients. The 1-, 3-, 6-, and 12- month PFS rates were 96%, 56%, 20%, and 4%, respectively. The OS rates at 6, 12, 24, 36, and 48 months were 96%, 52%, 28%, 8%, and 4%, respectively. The overall response was the only risk factor for the PFS in the univariate analysis (p=0.026), but not in the multivariate analysis (p=0.288). There was no independent prognostic factor of OS. No ablation-related mortality was observed. Major complication of liver abscess was observed in only 1 (4%) patient. RFA combined with PEI is a feasible treatment for HCC patients with PVTT, which might reduce the tumor burden and create conditions for further adjuvant therapy.