Virtual ultrasonography-assisted percutaneous ablation of hepatocellular carcinoma

Recent advances in multi-detector row computed tomography have enabled the synthesis of high-quality multiplanar reconstruction images. With this technique, arbitrary sectional images resembling conventional ultrasonography (US) images, i.e. virtual US images, can easily be created. We describe 3 cases of small hepatocellular carcinoma poorly visualized with US in which US-guided percutaneous ablation was safely and successfully performed with the assistance of the virtual US system. No local recurrence was found after a mean follow-up of 17 months. Percutaneous ablation using the virtual US system is a promising method for treating hepatocellular carcinoma poorly visualized with US.     

Post-recurrence survival in hepatocellular carcinoma after percutaneous radiofrequency ablation

Background

Overall survival in hepatocellular carcinoma patients treated with percutaneous radiofrequency ablation is influenced by both recurrence and successive treatments. We investigated post-recurrence survival after radiofrequency ablation.

Methods

Data on 103 early/intermediate patients initially treated with radiofrequency ablation and followed for a median of 78 months (range 68–82) were retrospectively analysed. If intrahepatic disease recurrence occurred within or contiguous to the previously treated area it was defined as local, otherwise as distant; recurrence classified as Barcelona Clinic Liver Cancer stage C was defined by neoplastic portal vein thrombosis or metastases.

Results

A total of 103 patients were included (82.5% male; median age 70 years, range 39–86). During follow-up, 64 recurrences were observed. Median overall survival was 62 months (95% confidence interval: 54–78) and survival rates were 97%, 65% and 52% at 1, 4 and 5 years, respectively. Median post-recurrence survival was 22 months (95% confidence interval: 16–35). Child–Pugh score, performance status, sum of tumour diameters at recurrence and recurrence patterns were independent predictors of post-recurrence survival.

Conclusions

In patients with hepatocellular carcinoma after radiofrequency ablation, clinical and tumour parameters assessed at relapse, in particular the type of recurrence pattern, influence post-recurrence survival.     

索拉菲尼在肝癌治疗中的不良反应

索拉菲尼可以显著改善晚期肝癌患者的预后,它主要通过拮抗血管内皮生长因子受体和血小板衍生生长因子受体抗血管源性靶点及通过抑制Raf/MEK/ERK信号传导通路直接抑制肿瘤生长而发挥抗肿瘤作用。然而,频发的索拉菲尼相关的不良反应将影响患者的生活质量。文中简述了小分子靶向药物索拉菲尼治疗肝癌的药理机制,归纳总结了索拉菲尼相关常见不良反应的发生率、特点、预防和治疗措施,并指出索拉菲尼相关的不良反应和抗肿瘤疗效相关,认为临床医生应该充分权衡索拉菲尼在治疗肝癌患者中不良反应的利与弊。     

Initial response to percutaneous ablation predicts survival in patients with hepatocellular carcinoma

Outcome predictors in patients with hepatocellular carcinoma (HCC) who are treated with percutaneous ablation are ill defined, and it is unknown if successful therapy is associated with improved survival. In our study, 282 cirrhotic patients with early nonsurgical HCC were treated with percutaneous ablation during a 15-year period. Single tumors were seen in 244 patients, and 2 to 3 nodules were seen in 38 patients. Initial complete response was achieved in 192 patients and was independently related to the size of the main tumor (P = .015) and tumor stage (P = .0001) (< or =2 cm, 96%; 2.1-3 cm, 78%; >3 cm, 56%; 2-3 nodules, 46%). At the end of follow-up, 80 patients presented sustained complete response. The 1-, 3-, and 5-year survival rates were 87%, 51%, and 27%, respectively. The independent predictors of survival were Child-Turcotte-Pugh class (P = .0001) and initial complete response (P = .006). Child-Turcotte-Pugh class A patients with initial complete response achieved 42% survival at 5 years; this figure increased to 63% in patients with tumors 2 cm or smaller. In conclusion, our results demonstrate that initial complete response to percutaneous ablation is associated with an improved survival in both Child-Turcotte-Pugh class A and B patients with nonsurgical HCC. Accordingly, initial complete tumor necrosis should be considered a relevant therapeutic target irrespective of tumor size and liver function.     

Angiographic adverse events during percutaneous coronary intervention fail to predict creatine kinase-MB elevation.

We attempted to determine if aggressive detection of angiographic adverse events during coronary intervention could predict subsequent creatine kinase (CK)-MB elevations. During coronary intervention, both fluoroscopy and cine angiography were used to detect angiographic adverse events. At least one angiographic adverse event occurred in 133/251 (53%) of procedures. CK-MB elevation occurred in 24% of procedures. Slow flow during the procedure (P=0.002) and chest discomfort at the end of the procedure (P=0.007) were the strongest predictors of CK-MB elevation. Among procedures with no angiographic adverse events, CK-MB elevation occurred in 15/121 (12%), accounting for 25% of CK-MB elevations. We conclude that CK-MB elevation occurs after angiographically uncomplicated coronary interventions even when angiographic adverse events are aggressively detected. Routine monitoring of cardiac enzymes is necessary to detect all patients who will experience myocardial injury after coronary intervention.     

Surgical vs percutaneous radiofrequency ablation for hepatocellular carcinoma in dangerous locations

AIM:To compare the long-term outcome of percutaneous vs surgical radiofrequency ablation(RFA) for hepatocellular carcinoma(HCC) in dangerous locations.METHODS:One hundred and sixty-two patients with HCC in dangerous locations treated with percutaneous or surgical RFA were enrolled in this study.The patients were divided into percutaneous RFA group and surgical RFA group.After the patients were regularly followed up for a long time,their curative rate,hospital stay time,postoperative complications and 5-year...     

超声引导经皮消融治疗肝细胞癌的临床运用

超声引导经皮消融治疗肿瘤的临床应用日益广泛,它在肝细胞癌(HCC)的治疗中最为成熟和作用最为显著有其内在原因.首先,肝脏及其局部病变在超声下显像良好,人路容易,疗效确实;其次,HCC的治疗难点一是患者多有肝功能损害,难以耐受侵袭度大的治疗方式,二是肿瘤有高度的复发倾向,需要反复多次治疗.经皮消融治疗的微创性、简便性恰好能对应这些难点.     

Radiofrequency ablation combined with percutaneous ethanol injection in patients with hepatocellular carcinoma

Background and study aimsHepatocellular carcinoma (HCC) is a major burden on health-care systems worldwide. Although radiofrequency ablation (RFA) is currently considered the best technique for coagulative necrosis, the superiority of concomitant use of RFA and percutaneous ethanol injection (PEI) needs to be determined. The study was designed to compare efficacy, safety and rate of survival of patients with HCC assigned to receive combined PEI–RFA versus RFA alone and versus PEI alone.Patients and methodsThis 3-year study enrolled 90 cirrhotic patients with HCC (Child’s class A or B, but not class C). They were randomly assigned for either PEI–RFA (group I), RFA alone (group II) or PEI alone (group III). The primary end point was ablation of the tumour. The secondary end point was rate of survival and recurrence.ResultsAfter the first session, complete ablation was significantly higher in the combination group (87.9%) compared with the RFA group (54.54%). After the second session, complete ablation was achieved in 97.0% of the combination group and in 84.8% of the RFA group. Regarding the PEI group, 75% had complete ablation, whereas 25% had partial ablation after multiple sessions. The survival rate, 1.5 years later, was significantly higher in group I (86.7%) compared with group III (63.3%). The overall incidence of serious adverse events was nil.ConclusionCombined treatment is superior to RFA alone and to PEI alone, in safety and efficacy in patients with HCC.     

Laparoscopic liver resection versus percutaneous radiofrequency ablation for small hepatocellular carcinoma

BackgroundLaparoscopic liver resection (LLR) and radiofrequency ablation (RFA) play central roles to treat early-stage hepatocellular carcinoma (HCC, ≤3 cm, 1–3 nodules, and no macrovascular involvement), although data are lacking regarding whether LLR or RFA is preferable. This study aimed to compare outcomes of both treatments for small HCCs.MethodsTreatment outcomes of small HCCs were compared between all the minor LLRs performed between 2005 and 2016 and RFAs performed between 2011 and 2016 at Kyoto University.ResultsA total of 85 and 136 patients underwent LLR and RFA, respectively. Patients that underwent LLR had higher incidence of blood transfusions, complications, and longer hospital stay. Overall and disease-specific survival rates were similar between LLR and RFA; however, recurrence-free (49.2% vs. 22.1% at 3-year) and local recurrence-free survival rates (94.9% vs. 63.6% at 3-year) were higher after LLR. Multivariate analyses identified that multiple nodules and 65-year-old and above are predictors of disease-specific survival, and that RFA is a predictor of recurrence and local recurrence.ConclusionRFA is less invasive, although both LLR and RFA are safe and effective. LLR provides better local control with superior recurrence-free and local-recurrence free survival. These results help optimize treatment selection based on patient-specific factors.     

A case of gouty arthritis following percutaneous radiofrequency ablation for hepatocellular carcinoma

Percutaneous radiofrequency thermal ablation(RFA) is considered an effective technique for providing local control in the majority of Hepatocellular carcinoma(HCC) patients.Although RFA is generally well tolerated,recent studies have reported complications associated with RFA.We describe a case of acute gouty arthritis in a 71-year-old man with chronic renal failure who was treated with RFA for a HCC lesion and who had hepatitis B-associated cirrhosis and mild renal insufficiency.Regular surveillance of the...     

Adjuvant percutaneous radiofrequency ablation of feeding artery of hepatocellular carcinoma before treatment

AIM： To evaluate the feasibility and efficacy of percutaneous radiofrequency ablation （RFA） of the feeding artery of hepatocellular carcinoma （HCC） in reducing the blood-flow-induced heat-sink effect of RFA.
METHODS： A total of 154 HCC patients with 177 pathologically confirmed hypervascular lesions participated in the study and were randomly assigned into two groups. Seventy-one patients with 75 HCCs （average tumor size, 4.3 ± 1.1 cm） were included in group A, in which the feeding artery of HCC was identified by color Doppler flow imaging, and were ablated with multiple small overlapping RFA foci [percutaneous ablation of feeding artery （PAA）] before routine RFA treatment of the tumor. Eighty-three patients with 102 HCC （average tumor size, 4.1 ± 1.0 cm） were included in group B, in which the tumors were treated routinely with RFA. Contrast-enhanced computed tomography was used as post-RFA imaging, when patients were followed-up for 1, 3 and 6 mo.
RESULTS： In group A, feeding arteries were blocked in 66 （88%） HCC lesions, and the size of arteries decreased in nine （12%）. The average number of punctures per HCC was 2.76 ± 1.12 in group A, and 3.36 ± 1.60 in group B （P = 0.01）. The tumor necrosis rate at 1 mo post-RFA was 90.67% （68/75 lesions） in group A and 90.20% （92/102 lesions） in group B. HCC recurrence rate at 6 mo post-RFA was 17.33% （13/75） in group A and 31.37% （32/102） in group B （P = 0.04）.
CONCLUSION： PAA blocked effectively the feeding artery of HCC. Combination of PAA and RFA significantly decreased post-RFA recurrence and provided an alternative treatment for hypervascular HCC.     

超声引导下经皮微波消融治疗近胃肠道肝细胞癌的疗效评价

目的 评价经皮微波消融结合温度监测及无水乙醇注射治疗近胃肠道肝细胞癌的安全性及临床疗效.方法 对263例患者共计319个肿瘤进行经皮微波消融治疗,其中101个距胃肠道≤5 mm的肿瘤为近胃肠道组,218个距肝表面、胃肠道和肝内一、二级分支管道＞5 mm肿瘤为对照组.近胃肠道组对无手术切除史患者肿瘤边缘温度控制在最高54～60℃,对有手术切除史患者边缘温度控制在最高50℃,对该组62个病灶近胃肠道边缘肿瘤组织内注射无水乙醇治疗.用独立样本t检验进行两组间均值比较,用秩和检验进行非参数分析,用卡方检验进行率的比较,用KaplanMeier法绘制局部肿瘤进展曲线,用Log-Rank检验分析两组不同随访时间局部肿瘤进展率之间的差异.结果 近胃肠道组96个肿瘤(95.0%)及对照组208个肿瘤(95.4%)获得完全消融.所有肿瘤局部进展均发生在术后12个月内,近胃肠道组与对照组第6个月局部肿瘤进展率分别为6.9%、7.3%,第12个月分别为11.9%、8.3%.两组均无并发症发生,无胃肠道及胆道损伤发生.结论 在严格温度监测下,微波消融联合无水乙醇注射可以安全治疗邻近胃肠道肝细胞癌并取得较好的完全消融效果.

Abstract：

Objective The purpose of the study was to prospectively evaluate safety and assisted with ethanol injection for hepatocellular carcinoma abutting gastrointestinal tract.Methods 263 patients with 319 hepatic tumors that underwent percutaneous microwave ablation with curative intention were included.101 lesions located less than 5 mm from gastrointestinal tract were in gastrointestinal group.218 lesions located more than 5 mm from hepatic surface,gastrointestinal tract and first or second branch of hepatic vessels were in control group.The temperature of marginal ablation tissue proximal to gastrointestinal tract was monitored and controlled to fluctuating between 45℃ and 59C for more than 10 min for tumors in the gastrointestinal group.Ethanol (1-21 ml) was injected into marginal tissue in 62 of 101 lesions of the G1 group.Results 96 of 101 tumors (95.0%) in the gastrointestinal group and 208 of 218 tumors (95.4%) in the control group achieved complete ablation (P = 0.89).Local tumor progression for all the tumors were in the first year and the 6-,12- month local tumor progression rate in the gastrointestinal group and the control group were 6.9%,11.9% and 7.3%,8.3%,respectively (P=0.21).There were neither immediate nor periprocedural complications in both groups.There was no delayed complication of gastrointestinal and bile ducts injury.Tumor seeding happened in one (1.1%) of the gastrointestinal group and three (1.8%) of the control group (P=0.92).Conclusion Under strict temperature monitoring,microwave ablation assisted with ethanol injection is safe and achieves a high complete ablation rate for hepatocellular carcinoma adjacent to gastrointestinal tract.     

肿瘤残余在肝癌微波消融治疗后出现的原因及防治

目的:探讨微波消融术后肿瘤残余的原因及防治措施.方法:回顾性总结了中国医科大学附属第四医院2004-10/2010-06 465例(796个肿瘤结节)肝癌患者行微波消融治疗的临床资料,分析了48例患者微波消融术后肿瘤残余的原因.结果:436例患者(754个肿瘤结节)获得有效复查资料,其中48例(48/436,11.01...     

Hepatic resection compared to percutaneous ethanol injection for small hepatocellular carcinoma using propensity score matching

BACKGROUND: Several surgical and non-surgical therapeutic modalities have been used for the treatment of hepatocellular carcinoma (HCC). There have been several studies comparing hepatic resection (HR) and percutaneous ethanol injection (PEI) for the treatment of HCC. However, there is still disagreement about the best treatment modality. METHODS: From 130 patients undergoing HR, 116 patients were individually matched to 116 controls from 249 patients undergoing PEI using propensity score matching to overcome possible biases in non-randomized study. Survival analyses were undertaken to compare these propensity score-matched groups. RESULTS: After matching by propensity score, the major clinical outcomes in the HR (n = 116) and the PEI (n = 116) groups were found to be similar. The 1-, 3- and 5-year overall survival rates were higher in the HR group (94.8%, 76.5% and 65.6%) compared to the PEI group (95.7%, 73.5% and 49.3%) (P = 0.059). The cumulative 1-, 3- and 5-year disease-free survival rates showed the same trend (HR: 76.1%, 50.6% and 40.6%; PEI: 62.6%, 25.5% and 19.1%) (P < 0.001). However, when stratified by Child-Pugh classification, it was no longer the case in the Child B patients. Single intrahepatic recurrence was the most common pattern of tumor recurrence after both treatments. CONCLUSIONS: Patients undergoing HR had a better survival profile than those undergoing PEI. However, when considering which technique to use for optimal HCC management, the individual patient's hepatic function must be considered.