Improved outcomes in primary hepatocellular carcinoma adjacent to large vessels: A combined approach of MRI-guided radiofrequency ablation and I implantation.

[PURPOSE] To assess the clinical efficacy and feasibility of combining MRI-guided radiofrequency ablation (RFA) with I seed brachytherapy for hepatocellular carcinoma (HCC) adjoining large vessels (≥3 mm diameter).

[MATERIALS AND METHODS] This single-center, retrospective cohort study analyzed prospectively collected data from March 2010 to March 2017. Approved by the institutional ethics review board, this retrospective analysis evaluated 84 patients with HCC situated near major vasculature, treated from March 2010 to March 2017. A total of 97 tumors underwent MRI-guided RFA combined with I seed implantation. Outcome measures included technical success, overall survival (OS), recurrence-free survival, local tumor progression, and comparative analyses between treatment-naive and previously treated subgroups.

[RESULTS] All interventions were completed without complications, achieving a primary technical efficacy rate of 98.81% (83/84). Postimplantation dosimetry confirmed adequate coverage in all cases (median D90 118 Gy, V100 94%). No seed migration or radiation-related toxicity (including radiation-induced liver disease) was recorded. The mean OS was 30.96 ± 18.98 months, with 1-, 3-, 5-, and 7-year OS rates of 100%, 98.20%, 87.10%, and 72.80%, respectively. Disease recurrence developed in 38.10% (32/84) of patients at a mean of 16.84 ± 13.61 months. Local tumor progression occurred in 7.1% (6/84). Significant intergroup differences emerged in portal hypertension (p = 0.009) and baseline AFP levels (p = 0.0015), with the treatment-naïve group demonstrating superior survival outcomes (p = 0.012).

[CONCLUSIONS] The combined approach of MRI-guided RFA and I brachytherapy represents a safe and effective strategy for managing HCC near major vasculature, providing high technical success rates and durable survival outcomes. Early intervention in treatment-naïve patients may be critical for outcome optimization. Prospective multicenter trials with extended follow-up are warranted to confirm these observations.