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Page 8 of 13 Bale et al. Hepatoma Res 2023;9:44 https://dx.doi.org/10.20517/2394-5079.2023.71

Table 2. Outcomes of stereotactic CT-guided percutaneous thermal ablation of iCCA
Tumor size (cm)
Author (Year) Technique n Diagnosis Median/Range; Median OS OS3 OS Major LR
OS
1 yr yr
5 yr Complications
Mean/SD
Stereotactic
RFA
Haidu et al. Multi-needle 11 Unresectable/Recurrent 3 (0.5-10) 60 mo 91% 71% N/A 13% LR SRFA:
[31]
(2012) SRFA iCCA 3/36
(8%)
Kim-Fuchs et al. Single-probe 10 Unresectable/ 2 (0.6-3.2) N/A N/A N/A N/A 10% LR
(2021) [64] SMWA Recurrent iCCA SMWA:
3/11
(27%)
SRFA / HR
vs. CTX
Braunwarth et al. SRFA (n = 16 Recurrent iCCA N/A 38 mo 88% 57% 49% LR SRFA:
(2022) [77] 11)/ HR (n = 1/11 (9%),
5) LR HR:
1/5
(20%)
Palliative 27 Recurrent iCCA N/A 17 mo 65% 17% 0%
treatment
CTX: Chemotherapy; HR: hepatic resection; iCCA: intrahepatic carcinoma; LR: local recurrence; mo: month; N/A: not available; OS: overall
survival; SMWA: stereotactic microwave ablation; SRFA: stereotactic radiofrequency ablation; yr: year.

respectively. The 1- and 3-year DFS rates were 62 and 22%, respectively, with a median DFS time of 24.3
months.

Patient morbidity or anatomical or functional limitations can preclude repeated hepatic resection. Thermal
ablation is a tissue- and anatomy-sparing technique that allows repeated treatments while preserving organ
function. In 2010, we described a case of a 72-year-old male patient with a 13-centimeter-diameter,
unresectable iCCA with intrahepatic metastases. Initially, the patient underwent three SRFA sessions . The
[66]
same patient received seven additional ablation sessions over nine years for ten recurrent intrahepatic
lesions in all eight Coinaud segments . Hospitalization periods were short, and procedure-related
[76]
discomfort was mild. The patient's liver function remained within the physiological range in spite of
multiple sessions one year after the last SRFA.

[77]
Another recent study from our group demonstrated that the application of multi-needle SRFA in
recurrent iCCA significantly increases the number of patients that can be re-treated with curative intent.
The efficacy, safety, and outcome of local versus palliative treatment for recurrent iCCA after SR were
compared in a total of 43 consecutive patients. Five patients underwent hepatic resection (1-2 sessions),
eleven patients underwent SRFA (1-9 sessions) with curative intent, and the other 27 patients had palliative
care. Patients who underwent repeated liver-directed therapy had OS similar to patients without recurrence
(P = 0.938) and better outcomes than patients who had palliative care (P = 0.018). 5-year OS among patients
without recurrence after initial resection versus patients who underwent repeated local curative liver-
directed therapy versus individuals who had palliative care were 54.3%, 47.7%, and 12.2%, respectively. The
rate of curative re-treatment increased from 11.9% to 37.0% when SRFA was added to SR as another
treatment option. Unresectable patients undergoing multi-needle SRFA had fewer local recurrences (1/11,
9%) vs. SR (1/5, 20%). Due to the outstanding short- and long-term outcomes, SRFA was recommended as
the initial local treatment for iCCAs in selected patients.