Radiofrequency Ablation Using Combined RF Energy Delivery Mode and Octopus Electrodes for Hepatocellular Carcinoma

**Inclusion Criteria**

• Agreement to the protocol requirements and provision of informed consent.
• Age between 20 and 85 years.
• Child-Pugh Class A or B7.
• Patients with liver cirrhosis who are candidates for radiofrequency ablation (RFA) based on multi-detector computed tomography (MDCT) or multi-detector computed tomography (MRI) within 60 days, with a suspected hepatocellular carcinoma (HCC) lesion of 1-3 cm.

• **HCC Diagnostic Criteria:** A. Presence of risk factors (e.g., hepatitis B virus (HBV) positive, hepatitis C virus (HCV) positive, liver cirrhosis).

B. Findings consistent with HCC on at least one imaging modality (MDCT, dynamic MRI, or Primovist MRI) according to the Korean Liver Cancer Association (KLCA) criteria.

C. Histological diagnosis of HCC.

• No prior history of HCC treatment, or if previously treated, no recurrence confirmed for at least two years.

**Exclusion Criteria**

• Presence of three or more malignant liver tumors.
• Diffuse infiltrative type tumors with unclear boundaries.
• Recurrent HCC within two years of previous treatment.
• Tumors adhered to major hepatic vessels or bile ducts by more than 5 mm.
• Poor tumor visibility even with contrast-enhanced ultrasound (CEUS)-fusion image guidance.
• Vascular invasion by malignant liver tumors.
• Severe coagulopathy (platelets <50,000/mm³ or International Normalized Ratio (INR) >50% prolongation).
• Presence of extrahepatic metastasis.
• Situations where obtaining appropriate data for the study is unlikely.