Radiofrequency ablation or microwave ablation combined with transcatheter arterial chemoembolization in treatment of hepatocellular carcinoma by comparing with radiofrequency ablation alone简

Objective：To compare radiofrequency ablation （RFA） or microwave ablation （MWA） and transcatheter arterial chemoembolization （TACE） with RFA or MWA monotherapy in hepatocellular carcinoma （HCC）.Methods：A prospective,randomized,controlled trial was conducted on 94 patients with HCC ≤7 cm at a single tertiary referral center from June 2008 to June 2010 at the Department of Hepatobiliary Surgery,the Second Affiliated Hospital of Southeast University.The patients were randomly assigned into the TACERFA or TACE-MWA （combined treatment group） and the RFA-alone or MWA-alone groups （control group）.The primary end point was overall survival.The secondary end point was recurrence-free survival,and the tertiary end point was adverse effects.Results：Until the time of censor,17 patients in the TACE-RFA or TACE-MWA group had died.The median follow-up time of the patients who were still alive for the TACE-RFA or TACE-MWA group was 47.5±11.3 months （range,29 to 62 months）.The 1-,3-and 5-year overall survival for the TACE-RFA or TACE-MWA group was 93.6％,68.1％ and 61.7％,respectively.Twenty-five patients in the RFA or MWA group had died.The median follow-up time of the patients who were still alive for the RFA or MWA group was 47.0±12.9 months （range,28 to 62 months）.The 1-,3-and 5-year overall survival for the RFA or MWA group was 85.1％,59.6％ and 44.7％,respectively.The patients in the TACE-RFA or TACE-MWA group had better overall survival than the RFA or MWA group [hazard ratio （HR）,0.526; 95％ confidence interval （95％ CO,0.334-0.823; P=0.002],and showed better recurrence-free survival than the RFA or MWA group （HR,0.582; 95％ CI,0.368-0.895; P=0.008）.Conclusions：RFA or MWA combined with TACE in the treatment of HCC ≤7 cm was superior to RFA or MWA alone in improving survival by reducing arterial and portal blood flow due to TACE with iodized oil before RFA.     

Ablation therapy of non-colorectal cancer lung metastases: retrospective analysis of tumour response post-laser-induced interstitial thermotherapy (LITT), radiofrequency ablation (RFA) and microwave ablation (MWA)

Purpose: To retrospectively compare the local tumour response and survival rates in patients with non-colorectal cancer lung metastases post-ablation therapy using laser-induced thermotherapy (LITT), radiofrequency ablation (RFA) and microwave ablation (MWA).

Material and methods: Retrospective analysis of 175 computed tomography (CT)-guided ablation sessions performed on 109 patients (43 males and 66 females, mean age: 56.6 years). Seventeen patients with 22 lesions underwent LITT treatment (tumour size: 1.2–4.8?cm), 29 patients with 49 lesions underwent RFA (tumour size: 0.8–4.5?cm) and 63 patients with 104 lesions underwent MWA treatment (tumour size: 0.6–5?cm). CT scans were performed 24-h post-therapy and on follow-up at 3, 6, 12, 18 and 24 months.

Results: The overall-survival rates at 1-, 2-, 3- and 4-year were 93.8, 56.3, 50.0 and 31.3% for patients treated with LITT; 81.5, 50.0, 45.5 and 24.2% for patients treated with RFA and 97.6, 79.9, 62.3 and 45.4% for patients treated with MWA, respectively. The mean survival time was 34.14 months for MWA, 34.79 months for RFA and 35.32 months for LITT. In paired comparison, a significant difference could be detected between MWA versus RFA (p?=?0.032). The progression-free survival showed a median of 23.49?±?0.62 months for MWA,19.88?±?2.17 months for LITT and 16.66?±?0.66 months for RFA (p?=?0.048). The lowest recurrence rate was detected in lesions ablated with MWA (7.7%; 8 of 104 lesions) followed by RFA (20.4%; 10 of 49 lesions) and LITT (27.3%; 6 of 22 lesions) p value of 0.012. Pneumothorax was detected in 22.16% of MWA ablations, 22.73% of LITT ablations and 14.23% of RFA ablations.

Conclusion: LITT, RFA and MWA may provide an effective therapeutic option for non-colorectal cancer lung metastases with an advantage for MWA regarding local tumour control and progression-free survival rate.     

TACE序贯MWA或RFA治疗原发性肝癌的疗效及安全性比较

目的:比较经导管肝动脉化疗栓塞（TACE）序贯微波消融术（MWA）或射频消融术（RFA）治疗原发性肝癌的疗效及安全性。方法:回顾性分析武汉协和医院接受治疗的原发性肝癌患者70例,将其分为TACE+MWA组36例与TACE+RFA组34例,比较两组临床疗效、生存率、肿瘤体积、血供消失率、完全坏死率、甲胎蛋白（AFP）水平、丙氨酸氨基转移酶（ALT）水平、天门冬氨酸氨基转移酶（AST）水平以及不良反应发生率。结果:TACE+MWA组疾病控制率（91.67%）与TACE+RFA组（88.24%）比较差异无统计学意义(P＞0.05);两组肿瘤体积、血供消失率、完全坏死率比较差异无统计学意义(P＞0.05);治疗后两组AFP水平与治疗前比较均明显降低(P＜0.05),组间比较差异无统计学意义(P＞0.05),治疗后两组ALT、AST水平与治疗前比较均明显升高(P＜0.05),且组间比较差异具有统计学意义(P＜0.05);两组6个月、1年、3年生存率比较差异无统计学意义(P＞0.05)。结论:TACE序贯MWA或RFA治疗原发性肝癌,疾病控制率、生存率、血供消失率与完全坏死率等无明显差异,均能有效控制肿瘤发展,促进AFP、ALT、AST等因子水平恢复至正常范围,延长生存期,且安全性尚可,临床可替换使用,但TACE+MWA组治疗后应注意加强保肝治疗。     

Microwave ablation is as effective as radiofrequency ablation for very-early-stage hepatocellular carcinoma

Background: Percutaneous radiofrequency ablation (RFA) is a first-line treatment for very-early-stage hepatocellular carcinoma (HCC), whereas the efficacy of percutaneous microwave ablation (MWA) for very-early-stage HCC remains unclear. The purpose of this study was to clarify this issue by comparing the safety and efficacy of percutaneous MWA with percutaneous RFA in treating very-early-stage HCC. Methods: Clinical data of 460 patients who were diagnosed with very-early-stage HCC and treated with percutane-ous MWA or RFA between January 2007 and July 2012 at the Eastern Hepatobiliary Surgery Hospital, The Second Mili-tary Medical University, in Shanghai, China were retrospectively analyzed. Of these 460 patients, 159 received RFA, 301 received MWA. Overall survival (OS), recurrence-free survival (RFS), local tumor progression (LTP), complete ablation, and complication occurrence rates were compared between the two groups, and the prognostic factors associated with survival were analyzed. Results: No significant differences were observed between the two groups in terms of the 1-, 3-, or 5-year OS rates (99.3%, 90.4%, and 78.3% for MWA vs. 98.7%, 86.8%, and 73.3% for RFA, respectively;P= 0.331). Furthermore, no signif-icant differences were observed between the two groups in terms of the corresponding RFS rates (94.4%, 71.8%, and 46.9% for MWA vs. 89.9%, 67.3%, and 54.9% for RFA, respectively;P= 0.309), the LTP rates (9.6% vs. 10.1%,P= 0.883), the complete ablation rates (98.3% vs. 98.1%,P= 0.860), or the occurrence rates of major complications (0.7% vs. 0.6%,P= 0.691). By multivariate analysis, LTP, antiviral therapy, and treatment of recurrence were independent risk fac-tors for OS (P < 0.001), and the alpha-fetoprotein level was an independent prognostic factor for RFS (P= 0.002). Conclusions: MWA is as safe and effective as RFA in treating very-early-stage HCC, supporting MWA as a first-line treatment option for this disease.     

大功率微波与射频消融治疗较大肝癌的近期疗效研究

目的 探讨大功率微波消融(microwave ablation,MWA)与射频消融(radiofrequency ablation,RFA)治疗较大肝癌的近期临床疗效及术后复发转移相关危险因素.方法 对101例未行其他治疗的原发性肝癌患者中45例(病灶数n=60)行大功率MWA治疗(80 ～ 100 W),56例(病灶数n=68)行RFA治疗.肿瘤直径范围为3～8cm,依据肿瘤直径分为两组:肿瘤直径3～ ＜5cm组及肿瘤直径≥5 cm组.消融后1月行超声造影、增强CT或MRI检查.观察治疗后两组患者肿瘤完全坏死率、局部复发率、并发症、生存情况,随访评价两种手术方式疗效并分析肝癌复发转移的相关危险因素.结果 大功率MWA与RFA对于3～ ＜5cm病灶1次完全坏死率分别为82.6％ (38/46)、80.0％ (40/50);2次完全坏死率分别为100.0％ (46/46)、98.0％ (49/50).MWA与RFA对于≥5cm病灶1次完全坏死率分别为64.3％ (9/14)、33.3％ (6/18);2次完全坏死率分别为85.7％ (12/14)、50.0％ (9/18).MWA与RFA组术后2年总复发率分别为40.0％ (18/45)、42.9％(24/56).MWA与RFA组术后1、2年生存率分别为95.6％ (43/45)、86.7％(39/45)及94.6％(53/56)、89.3％(50/56).两组患者并发症差异无统计学意义(P=0.802).单因素分析示术后复发转移与肿瘤个数(P=0.025)、术前AFP值(P=0.031)、乙肝HBV-DNA载量(P =0.035)及肿瘤病灶邻近危险区域(P=0.001)有关.多因素分析提示,乙肝HBV-DNA载量(P=0.023)与肿瘤病灶邻近危险区域(P=0.001)是肝癌消融治疗术后复发转移的独立危险因素.结论 MWA治疗较大肝癌的完全坏死率比RFA高,局部复发率比RFA低.肿瘤个数、术前AFP值、患者HBV-DNA病毒载量以及肿瘤病灶邻近危险区域都是肝癌术后复发转移的危险因素,其中后两者是独立危险因素.     

Quality of Life after Transcatheter Arterial Chemoembolization Combined with Radiofrequency Ablation in Patients with Unresectable Hepatocellular Carcinoma Compared with Transcatheter Arterial Chemoembolization alone

Aim: The aim of this study was to assess quality of life (QoL) in patients with unresectable hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) compared to TACE plus radiofrequency ablation (RFA) done at the same sitting, and to assess tumor therapy response after these 2 palliative interventions. Methods: 73 patients with unresectable HCC (BCLC-B) were included. Patients with tumor ≤ 5 cm were subjected to TACE (N = 45) while patients with tumors > 5 cm were subjected to TACE followed immediately by RFA (N = 28). QoL was evaluated with two validated questionnaires (EORTC QLQ-30 and EORTC HCC18). These questionnaires were filled out before intervention, 2 weeks and 2 months after intervention. Pre/post interventional changes were analyzed. The modified response evaluation criteria in solid tumor (mRECIST) were employed for the evaluation of therapeutic efficacy. Results: Baseline global health status/QoL was significantly higher in TACE group (64.1%) compared to TACE-RFA group (51.2%). Two weeks after intervention: the absolute decrease in global health state was higher in TACE-RFA (- 12.1%) compared to TACE (- 6.3%, p = 0.411). Less impairment was found in TACE group compared to TACE-RFA group for physical/social functioning, fatigue and pain but it was statistically insignificant. Two months after intervention; TACE-RFA group showed significant improvement in global health score, social and physical functioning scores, as well as significant improvement in pain and fatigue compared to TACE group. The therapeutic efficacy of TACE-RFA was better than TACE alone: complete remission, partial remission, stable disease and progressive disease were 17.9%, 32.1%, 42.9% and 7.1% Vs11.1%, 22.2%, 48.9% and 17.8%, respectively). Conclusion: Neither TACE nor TACE-RFA showed a significant decrease in QoL in patients with unresectable HCC two weeks after intervention. However, two months after intervention; TACE-RFA showed significant improvement in global health score compared to TACE monotherapy. TACE-RFA appeared safe, effective and more favorable than TACE monotherapy.     

结直肠癌肝转移患者经微波消融联合肝动脉栓塞化疗的效果和肝功能变化情况

目的探讨微波消融术(MWA)联合肝动脉化疗栓塞术(TACE)治疗结直肠癌肝转移中的临床疗效及其患者肝功能变化、生存情况以及生活质量评价。方法回顾性分析80例结直肠癌肝转移患者的临床相关资料,其中有38例单独行肝动脉化疗栓塞术治疗,为TACE组;其他42例行微波消融联合肝动脉栓塞化疗进行治疗,为MWA+TACE组。对2组的临床疗效、患者肝功能变化、生存情况以及生活质量评价数据进行整理分析。结果 TACE组和MWA+TACE组的临床有效率分别是39.5%和76.2%,MWA+TACE组患者的临床疗效显著优于TACE组患者(χ~2=11.098,P≈0.001)。2组患者的血清白蛋白、谷丙转氨酶、总胆红素含量等肝功能各项指标不存在统计学差异(P>0.05)。MWA+TACE组患者的2年、3年生存率显著高于TACE组(P<0.05)。在治疗6个月后,MWA+TACE组患者的生理状况、功能状况、情感状况、家庭/社会状况均显著高于TACE组患者(P<0.05);在总体评分上,MWA+TACE组患者显著优于TACE组(P<0.05)。结论微波消融联合肝动脉栓塞化疗治疗结肠癌肝转移有非常显著的效果,相对于单独化疗,能够延长患者的生存时间以及提高其生活质量,且对肝功能不会造成损害。     

Comparison of microwave ablation and radiofrequency ablation for hepatocellular carcinoma: a systematic review and meta-analysis

Background: Microwave ablation (MWA) has several advantages over radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma (HCC). We aimed to compare the efficacy and safety of MWA with those of RFA for HCC from the perspectives of percutaneous and laparoscopic approaches.

Methods: PubMed/MEDLINE, Embase, the Cochrane library, and China Biology Medicine databases were searched. Studies comparing the efficacy and safety of MWA with those of RFA in patients with HCC were considered eligible. Complete ablation (CA), local recurrence (LR), disease-free survival (DFS), overall survival (OS), and the major complication rate were compared between MWA and RFA.

Results: Four randomized controlled trials and 10 cohort studies were included. For percutaneous ablation, no significant difference was found between MWA and RFA regarding CA, LR, DFS, OS, and the major complication rate. A subgroup analysis of tumors measuring ≥3?cm revealed no difference in CA and LR for percutaneous ablation. For laparoscopic ablation, a significantly lower LR rate and a non-significant trend toward a higher major complication rate were observed for the MWA group (odds ratio [OR] 2.16, 95% confidence interval [CI] 1.16–4.02, p?=?.01 for LR; OR 0.21, 95% CI 0.04–1.03, p?=?.05 for major complication rate). CA, DFS, and OS were similar between the two groups.

Conclusions: Percutaneous (P)-MWA had similar therapeutic effects compared with P-RFA for HCC. Patients undergoing laparoscopic MWA had a lower LR rate; however, their major complication rate appeared to be higher. The superiority of MWA over RFA remains unclear and needs to be confirmed by high-quality evidence.     

Interventionelle Tumordestruktion durch thermische Verfahren

The aim of this article is to present interventional therapy methods based on thermal ablation, such as radiofrequency ablation (RFA), laser-induced thermotherapy (LITT) and microwave ablation (MWA) for palliative therapy of secondary malignant liver and lung tumors. This report provides information on data about local tumor control rates, survival data, progression-free survival (PFS) and complications. In liver metastases of colorectal carcinoma (CRC) the local tumor control rate is 85% for RFA, 95% for LITT and 93% for MWA, long-time survival is 22 months for RFA, 37 months for LITT and 32 months for MWA, progression-free survival is 84 months for RFA, 97 months for LITT and 93 months for MWA. Recent studies showed improved results with combined systemic and regional chemotherapy (e.g. TACE). Local recurrences of head and neck malignoma, lymph node infiltration and pelvic neoplasia are less frequent indications for tumor ablation.     

Higher Efficiency of Percutaneous Microwave (MWA) Than Radiofrequency Ablation (RFA) in Achieving Complete Response in Cirrhotic Patients with Early Hepatocellular Carcinoma

Background: Contrasting data are available in the literature regarding the superiority of percutaneous microwave ablation (MWA) or radiofrequency ablation (RFA) in very early or early (BCLA 0 or A) hepatocellular carcinoma (HCC). Aims: The primary outcome was to compare the efficacy of RFA and MWA in achieving complete response in cirrhotic patients with early and very early HCC. The secondary outcomes were to evaluate the overall survival and the recurrence rate. Methods: A retrospective, observational, single-center study was performed. Inclusion criteria were liver cirrhosis, new diagnosis of a single node of HCC measuring a maximum of 50 mm or up to three nodules with diameter up to 35 mm, treatment with RFA or MWA. Radiological response was evaluated with multiphasic contrast-enhanced Computed Tomography or Magnetic Resonance Imaging at 5–7 weeks after thermal ablation. Complete response was defined when no vital tissue was detected after treatment. Results: Overall, 251 HCC patients were included in this study; 81 patients were treated with MWA and 170 with RFA. The complete response rate was similar in MWA and RFA groups (out of 331 nodules, 87.5% (91/104) were treated with MWA and 84.2% (186/221) were treated with RFA, p = 0.504). Interestingly, a subanalysis demonstrated that for 21–35 mm nodules, the probability to achieve a complete response using MWA was almost 5 times higher than for RFA (OR = 4.88, 95% CI 1.37–17.31, p = 0.014). Moreover, recurrence rate in 21–35 mm nodules was higher with RFA with respect to MWA (31.9% versus 13.5%, p = 0.019). Overall survival was 80.4% (45/56) when treated with MWA and 62.2% (56/90) when treated with RFA (p = 0.027). No significant difference was observed between MWA and RFA treatment in the 15–20 mm nodules group. Conclusion: This study showed that MWA is more efficient than RFA in achieving complete response in HCC nodules with 21 to 35 mm diameter.     

Radiofrequency versus microwave ablation for intraoperative treatment of colorectal liver metastases

IntroductionIntraoperative radiofrequency ablation (RFA) and the newer technique of microwave ablation (MWA) can both be of additional value in parenchyma preserving surgical treatment of colorectal liver metastases (CRLM). MWA is less influenced by the heat-sink effect of surrounding vessels and can generate more heat in less time but RFA is still widely used. True comparing studies are scarce.MethodsThis single centre retrospective cohort study analyzed patients who underwent ultrasound guided intraoperative ablation as a part of the surgical treatment of CRLM between 2013 and 2018. In September 2015, MWA was substituted for RFA. Outcomes included unsuccessful ablation rates at 1-year postoperative, 30-days major complication rates, progression free survival (PFS) and overall survival (OS). Logistic regression models were used for univariable and multivariable analyses to identify predictors of unsuccessful ablation.ResultsForty-one patients underwent RFA of 98 lesions (median 2) and 79 patients underwent MWA of 193 lesions (median 2). The median diameter of the ablated lesions was 9 mm for both RFA and MWA. Unsuccessful ablation was observed in 7 metastases (7.1%) after RFA and 14 metastases (7.3%) after MWA (p = 1.000). Complications requiring re-intervention were observed after 8 procedures, 2 complications in the RFA group (4.9%) versus 6 complications in the MWA group (7.6%, p = 0.714), of which 6 were liver-related. Ninety-day mortality did not occur. Ablation technique was not associated with unsuccessful ablations. CRLM size was associated with unsuccessful ablation in the per lesion analysis (p < 0.001).ConclusionIntraoperative RFA and MWA were equally effective for treatment of small CRLM.     

射频消融治疗原发性肝癌的生命质量对比评价

背景与目的以往对原发性肝癌(hepatocellularcarcinoma,HCC)各种治疗疗效的评价主要从治愈率、生存率和生存时间方面进行,近年来生命质量(qualityoflife,QOL)研究倍受关注,能较全面地反映肝癌患者体能恢复状况和切身感受而被广泛应用于癌症、慢性病的疗效评价。目前对于经皮射频消融(radiofrequencyablation,RFA)、经动脉插管栓塞化疗(transcatheterhepaticarterialchemo-embolization,TACE)治疗意义的评价大多关注局部肿瘤灭活率及患者生存率,而对治疗后患者生命质量的研究尚不多见。本研究从患者整体角度对比评估原发性肝癌经皮射频消融治疗后患者的生命质量。方法采用国内肝癌特异性生命质量量表(QOL-LCV2.0),对80例HCC经RFA治疗后QOL进行评定;并与同期40例经动脉插管栓塞化疗(TACE组)以及TACE RFA(联合组)40例分别进行比较。3组患者在年龄、性别、临床分期等方面分布均衡,无明显差异。结果RFA组的QOL总分中位数(168.6)高于TACE组(146.8),差异有显著性(P=0.025);RFA组和联合组在症状/副作用领域的得分中位数45.5、46.0,分别优于单纯TACE组38.1(P<0.01);RFA组躯体功能领域得分呈略高于TACE组的趋势。患者的年龄、收入、治疗后Child-Pugh分级、治疗后新生/复发率、并发症等方面与患者生命质量相关。TACE组和联合组于治疗后Child-Pugh分级提高的比例分别高于RFA组;TACE组新生/复发的比例明显高于RFA组。RFA组的1年、2年和3年生存率(92.8%、89.3%和76.5%)与联合治疗组(94.1%、87.4%、60.0%)比较无统计学差异,但高于TACE组(74.3%、48.2%、48.2%)。结论RFA治疗肝癌,多数患者可获得较好的疗效,严重的副作用少。TACE与RFA联合治疗与单纯TACE相比,可减少患者肝功能损伤,有利于提高原发性肝癌患者的生命质量。     

Microwave ablation versus radiofrequency ablation for the treatment of hepatocellular carcinoma: A systematic review and meta-analysis

Purpose: Radiofrequency ablation (RFA) and microwave ablation (MWA) are the two main percutaneous techniques for the treatment of unresectable hepatocellular carcinoma (HCC). However, to date, studies comparing the two therapies have provided discordant results. The aim of this meta-analysis is to evaluate the efficacy and safety of the two treatments for HCC patients. Materials and methods: A computerised bibliographic search was performed on PubMed/MEDLINE, Embase, Google Scholar and Cochrane library databases. The rates of complete response (CR), local recurrence (LRR), 3-year survival (SR) and major complications were compared between the two treatment groups by using the Mantel-Haenszel test in cases of low heterogeneity or the DerSimonian and Laird test in cases of high heterogeneity. Sources of heterogeneity were investigated using subgroup analyses. In order to confirm our finding, sensitivity analysis was performed restricting the analysis to high-quality studies. Results: One randomised controlled trial (RCT) and six retrospective studies with 774 patients were included in the meta-analysis. A non-significant trend of higher CR rates in the patients treated with MWA was found (odds ratio (OR)?=?1.12, 95% confidence interval (CI) 0.67–1.88, p?=?0.67]. Overall LRR was similar between the two treatment groups (OR 1.01, 95% CI 0.53–1.87, p?=?0.98) but MWA outperformed RFA in cases of larger nodules (OR 0.46, 95% CI 0.24–0.89, p?=?0.02). 3-year SR was higher after RFA without statistically significant difference (OR 0.95, 95% CI 0.58–1.57, p?=?0.85). Major complications were more frequent, although not significantly, in MWA patients (OR 1.63, 95% CI 0.88–3.03, p?=?0.12). Conclusions: Our results indicate a similar efficacy between the two percutaneous techniques with an apparent superiority of MWA in larger neoplasms.     

Systematic review and meta-analysis of local ablative therapies for resectable colorectal liver metastases

IntroductionLocal ablative therapies (LAT) have shown positive but heterogenous outcomes in the treatment of colorectal liver metastases (CRLM). The aim of this systematic review is to evaluate LAT and compare them with surgical resection.MethodsIn accordance with PRISMA guidelines, Medline, EMBASE, Cochrane and Web of Science databases were searched for reports published before January 2019. We included papers assessing radiofrequency ablation (RFA), microwave ablation (MWA), cryoablation (CA) and electroporation (IRE) treating resectable CRLM with curative intention. We evaluated LAT related complications and oncological outcomes as tumour progression (LTP), disease-free survival (DFS) and overall survival (OS).ResultsThe literature search yielded 6767 records; 20 papers (860 patients) were included. No included studies related mortality with LAT. Median adverse events percentage was 7%: (8% RFA;7% MWA). Median 3y-DFS was 32% (24% RFA; 60% MWA); 5y-DFS was 27%: (18% RFA; 38.5% MWA). Median 3y-OS was 59% (60% RFA; 70% MWA; 34% CA), 5y-OS was 44.5% (43% RFA; 55% MWA; 20% CA).Surgical resection showed decreased LTP, improved DFS and OS than those reported with LAT, with RFA accounting for reduced 1y-DFS (RR 0.83, 95%CI 0.71–0.98), 3y-DFS (RR 0.5, 95%CI 0.33–0.76), 5y-DFS (RR 0.53, 95%CI 0.28–0.98) and 5y-OS (RR 0.76, 95%CI 0.58–0.98) in comparison with surgical resection.ConclusionsLow quality evidence suggests that both RFA and MWA seem superior to CA. MWA presents similar adverse events when compared to RFA with a possible increase in DFS and OS. Surgical resection still seems to provide superior DFS and OS in comparison with LAT.     

Percutaneous CT-guided thermal ablation as salvage therapy for recurrent non-small cell lung cancer after external beam radiotherapy: A retrospective study

Purpose: The aim of this study was to evaluate radiofrequency ablation (RFA) and microwave ablation (MWA) as a viable salvage option for patients with locally recurrent non-small cell lung cancer (NSCLC) after radiotherapy. Materials and methods: This retrospective study was conducted on patients who had received thermal ablation for recurrent NSCLC post-curative radiotherapy. Medical records and follow-up imaging with computed tomography (CT) and PET-CT were analysed to determine time to local progression (TTLP) and overall survival (OS). TTLP was determined according to the modified RECIST criteria. Results: Twelve patients, mean age 71?±?7 years, received 17 thermal ablation sessions, with RFA performed for four lesions and MWA for 13. Nine tumours were squamous cell cancers (SCC) and eight were adenocarcinomas. Eleven tumours had recurred post-external beam radiation and one post-stereotactic body radiation therapy. Mean tumour size was 34.2?±?12.8?mm, tumour stages prior to radiotherapy were Ia (2), Ib (3), IIa (4), IIb (1) and III (2). Follow-up period was 19?±?11 months. Overall median TTLP was 14 months (95% CI: 8, 19), and median OS was 35 months (95% CI: 12, 58). Mean TTLP for tumours <30?mm was 23 months and for tumours >30?mm 14 months (p?=?0.20). Recurrence rates reduced from 50% after initial ablation to 20% with a second ablation. Complication rate for pneumothorax requiring intervention was 17%. Conclusion: Both RFA and MWA ablation prolonged local tumour control with minimal morbidity in this study group of recurrent NSCLC after radiotherapy.     

Transcatheter arterial chemoembolization plus radiofrequency ablation therapy for early stage hepatocellular carcinoma

BACKGROUND:

Radiofrequency ablation (RFA) is becoming a well‐known local therapy for hepatocellular carcinoma (HCC). Transcatheter arterial chemoembolization (TACE) is expected to enhance the effects of subsequent RFA by reducing arterial blood flow. However, the long‐term efficacy of this combined therapy has not been elucidated. In this study, the survival rates of patients who received TACE combined with RFA (TACE + RFA) were compared with those of patients treated surgically.

METHODS:

The study included consecutive patients who received TACE + RFA or surgical resection as the initial curative treatment for HCC between 2000 and 2005 at Tokai University Hospital. Inclusion criteria were a single HCC ≤50 mm or up to 3 HCCs ≤30 mm, presence of cirrhosis classified as Child‐Pugh class A, no vascular invasion, and no extrahepatic metastasis.

RESULTS:

Sixty‐two patients (23 women, 39 men; aged 67.5 ± 8.4 years [mean ± standard deviation]) received TACE + RFA, and 55 patients (15 women, 40 men; aged 66.1 ± 8.4 years) underwent surgical resection. Median follow‐up periods were similar (50 months in the TACE + RFA group vs 49 months in the resection group). The probabilities of overall survival at 1, 3, and 5 years in the TACE + RFA group (100%, 94.8%, and 64.6%, respectively) were similar (P = .788) to those in the resection group (92.5%, 82.7%, and 76.9%, respectively). Two major RFA‐related complications were observed (1.5%).

CONCLUSIONS:

RFA combined with TACE is an efficient and safe treatment that provides overall survival rates similar to those achieved with surgical resection. Cancer 2010. © 2010 American Cancer Society.     

经皮射频消融术治疗外科切除术后复发性肝细胞癌疗效分析

背景与目的：大部分复发性的肝癌结节的直径小于3 cm,且射频消融(radiofrequency ablation,RFA)治疗直径小于3 cm的肿瘤结节,其疗效已受到广泛认可。探讨RFA对手术切除术后复发性肝细胞癌(hepatocellular carcinoma,HCC)的临床疗效与安全性。方法：回顾性分析61例手术切除后复发性HCC患者在经动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)结合RFA的治疗下的1、3、5年总生存(overall survival,OS)率和无进展生存(progression-free survival,PFS)率,并发症发生率,死亡率,完全消融率以及影响患者生存率的独立风险因子。结果：完全消融率为93.4%(57/61),不完全消融率6.6%(4/61)。1、3、5年生存率分别为96.3%、77.9%和77.9%。1、3、5年PFS率分别为48.6%、20.3%和13.5%。消融术后出现主要并发症的患者1例,为肝包膜下出血;无消融治疗相关的死亡患者;消融后住院时间为4~7 d,中位值为5 d。影响OS的独立风险因子为患者HBsAg阳性(P=0.044,HR=7.496,95%CI：1.057~53.152)。结论：RFA治疗手术切除术后复发的HCC安全、有效,能够有效提高切除术后复发性HCC患者的生存率,对改善HCC患者的预后具有重要意义。     

Percutaneous radiofrequency ablation for malignant liver tumours in challenging locations

Purpose: To evaluate the treatment results of radiofrequency ablation (RFA) for primary and metastatic malignant liver tumours in challenging locations and also to present the treatment strategy that was used in these cases. Patients and Methods: From January 2007 to January 2010, we performed CT‐guided RFA on 528 lesions in 402 patients (265 men and 137 women; mean age 65.1 years, range 19–82 years) with liver tumours (primary and metastatic) of which 98 lesions in 84 patients (55 men and 29 women; mean age 67.8 years, range 33–82 years) were located in challenging locations, defined as less than 5 mm from a large vessel or an extrahepatic organ (heart, lung, gall bladder, right kidney or gastrointestinal tract). The sizes of the tumours ranged 1.5–6 cm. We used two different RFA systems with an expandable needle electrode (RITA; Rita Medical Systems, Inc, Mountain View, CA, USA and MIRAS; Invatec S.r.l., Roncadelle, Italy).The tumours were considered as ablated completely if no viability was found on dual‐phase dynamic contrast‐enhanced CT at 1 month after RFA. Results: Complete ablation was obtained in 89.7% (88/98) of the high‐risk located lesions, while 10 (10.3%) of the lesions were managed with repeated RFA because of tumour residue. The 1‐, 2‐ and 3‐year survival rates were 82.6, 67.3 and 54.1%, respectively. Minor complications occurred in eight of the 84 patients (9.5%), including small sub‐capsular haematoma in four, small pleural effusion in three and partial liver infarction in one. Local tumour progression rate was 9.2% (9/98). Conclusion: RFA is a safe and effective method of treatment of primary and metastatic liver tumours even located in challenging locations when performed by a well‐trained and experienced interventional radiologist.     

肝动脉栓塞化疗后射频消融联合酒精消融对原发性肝癌的疗效评价

目的　探讨肝动脉栓塞化疗(TACE)后,CT导向下射频消融(RFA)联合无水乙醇消融(PEI)对原发性肝癌(HCC)的治疗效果。方法　经病理、AFP或典型影像学诊断证实的HCC 1 5 0例,每例肝内的病灶数目<3个,病灶大小3.1～7.9cm ,平均直径5 .5cm。全部患者按就诊单双日分为对照组和联合组。对照组74例,TACE后2周行单纯RFA ;联合组76例,TACE后2周行射频消融,间隔2 0～30d后再行PEI。结果　对照组的完全坏死率为75 .8%,联合组为89.5 %,两组间差异有统计学意义(P <0 .0 5 )。结论　HCC患者经TACE后,行CT导向下RFA联合PEI的疗效明显优于单纯RFA。     

Clinical Application of Transcatheter ArterialChemoembolization Combined with Synchronous C-armCone-Beam CT Guided Radiofrequency Ablation in treatmentof Large Hepatocellular Carcinoma

Objective: This work aimed to evaluate the safety and clinical efficacy of transcatheter arterialchemoembolization (TACE) combined with c-arm cone-beam CT guided synchronous radiofrequency ablation(RFA) in treatment of large hepatocellular carcinoma (HCC). Methods: 21 patients with large HCC were studiedfrom January 2010 to March 2012. TACE combined with synchronous C-arm cone-beam CT guided RFA wereperformed on a total of 25 lesions. Conventional imaging examination (CEUS, enhanced CT or MRI) and AFPdetection were regularly conducted to evaluate the technical success rate of combined treatment, complications,treatment response, time without disease recurrence and survival rate. Results: The technical success rate ofcombined treatment was 100%, without any significant complication. After 1 month, there were 19 cases withcomplete response and 2 cases with partial response, with an complete response rate of 90.4% (19/21) and aclinical effective rate of 100% (21/21). The complete response rates of single nodular lesions (100%, 17/17) wassignificantly higher than that of multiple nodular lesions (50%, 2/4) (P < 0. 05). During 2 to 28 months of followup,in 19 cases with complete response, the average time without disease recurrence was 10.8 ± 6 months. Thetotal survival rates of 6, 12 and 18 months in 21 patients were 100%, respectively. Conclusion: TACE combinedwith synchronous C-arm CT guided RFA is safe and effective for treatment of large HCC. The treatment efficacyfor single nodular lesion is better than that for multiple nodular lesions.