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Page 4 of 13 Bale et al. Hepatoma Res 2023;9:44 https://dx.doi.org/10.20517/2394-5079.2023.71

Follow-up after thermal ablation
Patient follow-up usually includes an early treatment response assessment by contrast-enhanced CT scan or
magnetic resonance imaging (MRI) performed within 1 month after treatment, followed by imaging at 3-6
month intervals [31-37] . Assessment at one month after the intervention defines technical effectiveness. When
no suspicious contrast enhancement is observed in the periphery or the ablated area, then tumor necrosis is
deemed complete. Nodular intralesional or peripheral contrast enhancement on CT or MRI imaging and/or
an increase in tumor size define recurrence [31-37] .

Outcomes after conventional US- and CT- guided thermal ablation [Table 1]
Radiofrequency ablation
[38]
In 2002, Slakey reported the first successful use of RFA in a patient with recurrent iCCA after SR.
Chu et al. reported the results of percutaneous US-guided RFA of 40 patients with recurrent iCCA with a
[39]
tumor size < 5 cm after SR . The median OS from the date of SRFA was 26.6 months, and the
corresponding 3- and 5-year OS were 36.2% and 18.3%, respectively. Kim et al. treated 20 patients with 29
[40]
recurrent iCCAs (mean tumor size: 1.9 cm) with ultrasound-guided percutaneous RFA . The mean local
tumor progression-free survival (PFS) was 39.8 months. Reported 1- and 4-year survival was 93% and 74%,
with a median OS of 27.4 months after RFA. Two major complications (7%, one liver abscess, and one
biliary stricture) were reported. The same group reported outcomes after RFA of primary unresectable
iCCAs in 13 patients . One liver abscess (6%) was observed. RFA achieved a median OS and 1-, 3-, and 5-
[41]
year survival of 38.5 months, and 85%, 51%, and 15%, respectively. Carrafiello et al. reported a median OS of
20 months after RFA of primary unresectable iCCAs in six patients . In two large lesions, pre-
[42]
interventional transarterial embolization was performed to decrease the “heat sink” during RFA. Brandi et
al. treated 29 patients with unresectable ICCA with a tumor size of larger than 5 cm with percutaneous US-
guided RFA .
[28]

The authors reported a LTPFS of 9.3 months and a median OS of 27.5 months. The major complication rate
was 7%. Butros et al. treated seven patients with nine iCCAs with percutaneous US-guided RFA. Local
[43]
tumor control was achieved in 8/9 tumors . The mean OS was 39 months (range: 12-69 months).

Microwave ablation
In an early series, Yu et al. treated 15 patients with 24 iCCA lesions (mean tumor size, 3.2 ± 1.9 cm) with
ultrasound-guided MWA in 38 sessions . Major complications occurred in three patients, including two
[44]
liver abscesses (13.3%) and one needle seeding (6.7%). During a mean follow-up of 12.8 months, 6/24
lesions (25%) demonstrated local tumor progression. The cumulative 6-, 12-, and 24-months OS were
78.8%, 60.0%, and 60.0%, respectively. Wang et al. treated 29 patients with 58 iCCAs (mean diameter: 2.7
[45]
cm) with US-guided MWA . With 18 months of median follow-up, cumulative 1- and 3-year OS was
64.4% and 48.1%, respectively. Postoperative extrahepatic metastasis was associated with worse long-term
survival (P = 0.006).

Ni et al. reported that ALBI grade predicted long-term outcomes of CT-guided MWA of iCCAs in 78
patients . With 23 months of median follow-up, cumulative 1-, 3-, and 5-year OS was 89.5%, 52.2%, and
[46]
35.0%, respectively. OS was higher among patients with ALBI grade 1 compared with patients who had
ALBI grade 2 (P < 0.001). In a similar study, Yang et al. reported 52 patients with 74 iCCA lesions who
underwent MWA . The incidence of major complications was 3.8% and the 1-, 3-, and 5-year OS was
[47]
87.4%, 51.4%, and 35.2%, respectively. Older age (P = 0.002), tumor size > 3 cm (P = 0.021), and albumin
bilirubin (ALBI) grade (P = 0.004) were negative predictors of OS.