Low-output radiofrequency ablation combined with transcatheter arterial oily-chemoembolization for hepatocellular carcinoma

We devised low-output radiofrequency ablation (RFA)combined with transcatheter arterial chemoembolization using iodized oil mixed with anticancer drugs (TACE) for hepatocellular carcinoma (HCC), to reduce the cooling effect of tumoral arterial blood flow, to prevent intraportal disseminations and intrahepatic metastases by sudden ebullition (bumping), and to obtain an adequate margin of safety. We performed low-output RFA on 10 HCC patients. We performed RFA with a lower output of 90W or less within two weeks after TACE. After the ablation, portal venous-phase CT images showed a low-density margin of 5 mm or larger around the site of iodized-oil accumulation, indicating that the necrotic area completely included the tumor. No intrahepatic metastasis or severe complication occurred. Low-output RFA combined with TACE is a safe, effective therapy for HCC.     

腹腔镜射频消融治疗原发性肝癌的研究

目的：评价腹腔镜射频消融（RFA）治疗原发性肝癌的可行性、安全性及疗效。方法：51例原发性肝癌在全麻下行腹腔镜RFA治疗,共72个瘤体,平均最大肿瘤直径（3．4±1．0）cm。合并肝硬化49例、慢性结石性胆囊炎5例,糖尿病4例,凝血功能障碍10例。结果：51例均顺利完成腹腔镜RFA治疗,12例行腹腔镜胆囊切除术。未出现严重并发症。肿瘤完全坏死率为95．8％。随访12～58个月（平均35个月）,6例发现肝内新病灶,11例射频治疗部位复发,再次采用经皮RFA治疗9例,12例死于肿瘤复发或肝功能衰竭。结论：腹腔镜RFA治疗原发性肝癌安全可行,治疗效果可靠,但应选择瘤体位于肝脏表面或临近胆囊而且不宜手术切除的病例进行治疗。     

Thoracic tumors treated with CT-guided radiofrequency ablation: initial experience

PURPOSE: To determine the effectiveness of computed tomography (CT)-guided radiofrequency (RF) ablation of malignant thoracic tumors. MATERIALS AND METHODS: CT-guided RF ablations of 99 malignant thoracic tumors (3-80 mm in largest diameter; mean, 19.5 mm) were performed in 35 patients in 54 sessions. Ablation was performed with an RF generator by using a single internally cooled electrode. Tumors were both primary (three lesions) and secondary (pulmonary or pleural metastases, 96 lesions). Follow-up was 1-17 months (mean, 7.1 months). Follow-up CT and histopathologic examinations were evaluated. Univariate analysis was performed with the Fisher exact test, and Welch t test was used to evaluate differences between group means. P <.05 represented a significant difference. The maximal diameter of each residual tumor or local recurrence or the proportion of primary lesions of pulmonary metastatic tumors with recurrence after RF ablation were analyzed. Complications, management, and outcomes of the complications were recorded. RESULTS: The appearance of each ablation zone, including the target tumor and surrounding normal lung parenchyma, showed involution at follow-up CT. Local recurrence was demonstrated histopathologically or radiologically in nine tumors. The other 90 tumors showed no growth progression at follow-up CT. Probable complete coagulation necrosis obtained with initial RF ablation was achieved in 91% (90 of 99) of the tumors. The mean maximal diameter of the nine tumors (19.6 mm +/- 7.7 [SD]) was not significantly different (P =.994) from that of the other 90 tumors (19.5 mm +/- 13.0). Primary lesions of those nine metastatic tumors varied and did not demonstrate a specific tendency. Complications included pneumothorax, fever higher than 37.5 degrees C, hemoptysis, cough, pleural effusion, abscess formation, and hemothorax. The overall complication rate was 76% (41 of 54 sessions). CONCLUSION: RF ablation seems to be a promising treatment for malignant thoracic tumors.     

膈下肝癌经肝动脉化疗栓塞联合射频消融的临床疗效分析

【摘要】　目的?评估经肝动脉化疗栓塞（TACE）联合射频消融（RFA）治疗膈下肝癌的安全性与有效性。方法?选取2014年3月至2018年11月行TACE联合RFA治疗的膈下肝癌患者55例。随访期间评估所有患者术后肿瘤反应及生存率,比较治疗前后血生化、AFP及肝功能指标变化,并总结患者术后并发症的发生情况。结果?在55例肝癌患者共61处膈下病灶中,30处病灶（49.2%）完全缓解（CR）,24处病灶（39.3%）部分缓解（PR）,7处病灶（11.5%）疾病稳定（SD）,无病灶疾病进展（PD）。客观反应率（ORR）为88.5%,疾病控制率（DCR）为100%,所有患者均获益。治疗前后肝功能及血生化指标无明显差异（P＞0.05）,但术后AFP值明显下降,差异具有统计学意义（t?=3.277,P＜0.05）。所有患者在围手术期未出现严重并发症。结论?TACE联合RFA对膈下肝癌疗效显著。在RFA治疗过程中出现的疼痛,通过术前静脉滴注氟比洛芬酯或地佐辛并联合利多卡因局麻,术中加入适量利多卡因与0.9%NaCl溶液1:1稀释液经进水孔对肿瘤病灶进行灌注麻醉,必要时给予吗啡肌注,可显著缓解患者疼痛。     

Multipolar radiofrequency ablation of hepatic tumors: initial experience

Institutional review board approval and patient informed consent were obtained. Use of a multipolar radiofrequency (RF) ablation device in patients with hepatic malignancy was prospectively evaluated with regard to feasibility, achieved ablation zone size and shape, technical effectiveness, and complications. Nineteen malignant liver tumors were treated with the multipolar resistance-controlled RF ablation system, with which up to three internally cooled bipolar coagulation electrodes can be operated simultaneously. Postinterventional imaging was performed with dynamic contrast material-enhanced magnetic resonance (MR) imaging and MR imaging-based three-dimensional planimetry. Complete tumor destruction was achieved in 18 of 19 tumors. Mean ablation zone volume was 52 mL +/- 45 (standard deviation). Thirteen patients were treated with a percutaneous approach; six, with an intraoperative approach. Maximum ablation size was 91 x 62 x 79 mm with the percutaneous and 73 x 98 x 74 mm with the intraoperative approach. Of the 18 completely evaluable ablation zones, 13 were concentric, two were moderately eccentric, two were eccentric, and one was wedge-shaped. The multipolar RF ablation device achieves large ablation zones and has high technical effectiveness in treating hepatic tumors.     

CT引导下人工腹水结合三维可视化系统辅助射频消治疗难消融复发性肝癌

【摘要】 目的 评价CT引导下人工腹水结合三维可视化系统（3DVAPS）辅助射频消融治疗难消融的复发性肝癌的临床疗效和安全性。方法 回顾性分析中山大学肿瘤防治中心2015年3月至2020年12月177例复发性肝细胞癌患者的CT引导下射频消融的资料,其中257个病灶位于有挑战性的消融困难部位。肿瘤预后包括消融相关并发症、人工腹水技术成功率、完全消融技术成功率。 结果 177例患者的腹腔注入0.9%氯化钠溶液100~3 000 mL,平均853.71 mL,其中169例（95.48%）成功诱导人工腹水。术后复查腹部CT可见腹腔注水全部消失,其中仅有94例（53.11%）术中出现轻微并发症,均未出现严重并发症。术后162例患者消融边缘充分,增强扫描示消融区无强化。CT引导下人工腹水结合3DVAPS辅助射频消融手术的完全消融技术成功率为91.53%（162/177）。 结论 CT引导下人工腹水结合3DVAPS辅助射频消融治疗难消融复发性肝癌是一种安全、有效的治疗方法。     

Recurrent hepatocellular carcinoma: percutaneous radiofrequency ablation after hepatectomy

PURPOSE: To evaluate the therapeutic efficacy and safety of percutaneous radiofrequency (RF) ablation for recurrent hepatocellular carcinoma (HCC) in the liver after hepatectomy. MATERIALS AND METHODS: Forty-five patients with 53 recurrent HCC tumors in the liver underwent percutaneous RF ablation with ultrasonographic guidance. All patients had a history of hepatic resection for HCC. The mean diameter of recurrent tumors was 2.1 cm (range, 0.8-4.0 cm). All patients were followed up for at least 10 months after ablation (range, 10-40 months; mean, 23 months). Therapeutic efficacy and complications were evaluated with multiphase helical computed tomography (CT) at regular follow-up visits. Overall and disease-free survival rates were calculated. RESULTS: At follow-up CT after initial RF ablation, 11 (21%) of 53 ablated HCC tumor sites showed residual tumor or local tumor progression. After additional RF ablation, complete ablation of 46 (87%) of 53 tumors was attained. Also at initial follow-up CT, before either additional RF ablation or other treatment was performed, 21 (47%) of 45 patients were found to have 41 new HCC tumors at other liver sites. Of these, nine tumors in eight patients were treatable with a second application of RF ablation. Overall survival rates at 1, 2, and 3 years were 82%, 72%, and 54%, respectively. No deaths or complications requiring further treatment occurred as a result of RF ablation. CONCLUSION: Percutaneous RF ablation is an effective and safe method for treating recurrent HCC in the liver after hepatectomy, with a good overall patient survival rate.     

无水酒精注射术联合射频消融术与单纯射频消融术治疗小肝癌的疗效比较

目的比较无水酒精注射术（PEI）联合射频消融术（RFA）治疗方案与单纯RFA治疗小肝癌的疗效。方法回顾分析我院2006年1月～2008年1月进行的68例小肝癌射频消融治疗患者的临床资料。68例中37例行PEI联合RFA术,31例行单纯RFA术。比较两组肿瘤完全消融率,复发率,复发时间,术后1、2、3年生存率等情况。结果 PEI联合RFA组肿瘤完全消融率91.89%,局部复发率10.81%,局部复发时间（14.22±3.48）月,1、2、3年的生存率分别为89.19%、81.08%和72.97%。单纯RFA组肿瘤完全消融率70.97%,局部复发率32.26%,局部复发时间（9.15±2.68）月,1、2、3年的生存率87.10%、77.42%和48.39%。PEI联合RFA组在肿瘤完全消融率、局部复发率、复发时间、术后3年生存率方面好于单纯RFA组。结论 PEI联合RFA治疗小肝癌疗效优于单纯RFA治疗,在小肝癌的治疗中有重要临床应用价值。     

CT fluoroscopy-guided radiofrequency ablation of osteoid osteoma with double nidi

Osteoid osteoma (OO) is a common benign bone tumor, usually found in children and young adults. Fewer than 30 cases of multicentric OO in a single bone have been reported in the world literature. We present the case of a 17-year-old boy with OO in the left tibia, containing double nidi. Plain radiography and computed tomography (CT) revealed two adjacent nidi surrounded by bony sclerosis within the distal left tibia. The tumor was successfully treated using two separate CT fluoroscopy-guided percutaneous radiofrequency ablations during a single session. The patient achieved complete pain relief the next day, and has remained asymptomatic for 9 months since treatment.     

Imaging-guided percutaneous radiofrequency ablation of pulmonary metastatic nodules caused by hepatocellular carcinoma: preliminary experience

OBJECTIVE: The purpose of our study was to evaluate the efficacy of imaging-guided percutaneous radiofrequency ablation of metastatic pulmonary nodules caused by hepatocellular carcinoma. CONCLUSION: Percutaneous radiofrequency ablation is feasible and can be a promising method for the local control of metastatic pulmonary nodules caused by hepatocellular carcinoma, especially when they are limited in number.