Incremental High Power Radiofrequency Ablation with Multi-electrodes for Small Hepatocellular Carcinoma: A Prospective Study

Radiofrequency ablation (RFA) offers a minimally invasive treatment for small hepatocellular carcinoma (HCC), yet faces challenges like high local recurrence rates. A novel approach using a three-channel, dual RF generator with separable clustered electrodes aims to improve RFA's efficacy and safety. This prospective study, conducted from January 2020 to July 2022, evaluated a high-power, gradual, stepwise RFA method on HCCs (≤4 cm), utilizing real-time US-CT/MR fusion imaging. The study, involving 110 participants with 116 HCCs, reported no major complications. Local tumor progression (LTP) and intrahepatic remote recurrence (IRR) were low, with 1-year, 2-year, and 3-year cumulative incidences showing promising rates of LTP (0.9%, 3.6%, 7.0%) and IRR (13.9%, 20.5%, 31.4%). Recurrence-free survival (RFS) rates were similarly encouraging: LTP (99.1%, 96.4%, 93.0%) and IRR (86.1%, 79.5%, 68.6%). This innovative gradual, incremental high-power RFA technique, featuring a dual switching monopolar mode and multiple electrodes, represents an effective and safer management option for small HCCs. Trial registration: clinicaltrial.gov identifier: NCT05397860, first registered on 31/05/2022