肝动脉化疗栓塞术联合微波消融治疗原发性大肝癌疗效观察

目的观察肝动脉化疗栓塞术(TACE)联合微波消融治疗原发性大肝癌的疗效。方法将60例大肝癌(肿瘤直径>5 cm)患者按照治疗方法分为观察组28例和对照组32例,观察组采用TACE联合微波消融治疗,对照组仅行TACE。观察两组疗效,ELISA法检测治疗前后血清甲胎蛋白(AFP),记录中位生存时间及6、12、18、24个月累计生存率。结果观察组治疗总有效率为96.4%,对照组为81.3%,两组比较,P<0.05。观察组治疗前后血清AFP水平分别为(399.13±430.214)、(235.31±308.047)U/L,对照组分别为(491.90±439.203)、(609.81±420.135)U/L,两组治疗前与治疗后比较,两组治疗后比较,P均<0.05。观察组中位生存时间为10个月,对照组为7个月。观察组、对照组6个月生存率分别为89%、50%,12个月生存率分别为18%、0,18个月生存率分别为4%、0,24个月生存率分别为0、0,两组6个月、12个月生存率比较,P均<0.05。结论与单行TACE比较,TACE联合微波消融治疗原发性大肝癌疗效较好,且术后患者生存率高。     

肝动脉化疗栓塞术联合阿德福韦酯治疗原发性肝癌的疗效观察

目的 探讨经皮肝动脉栓塞化疗术(TACE)联合阿德福韦酯治疗原发性肝癌的临床疗效.方法 将106例原发性肝癌患者随机分为观察组和对照组各53例,两组均采用Seldinger技术行TACE治疗,予以肝动脉化疗和碘油栓塞;在此基础上,观察组同时口服阿德福韦酯10 mg、1次/d.治疗前后两组均行甲胎蛋白(AFP)检测及影像学检查,观察肿瘤变化、碘油沉积情况及其充填面积占肿瘤总面积的百分率;并观察记录两组临床疗效.结果 与治疗前及对照组比较,观察组的AFP降低(P＜0.05);总有效率(75.48％)显著高于对照组(60.38％)(P＜0.05).观察组1、2、5年生存率分别为90.57％、75.47％和54.72％;对照组分别为83.02％、54.72％和37.74％,两组比较P均＜0.05.结论 TACE联合阿德福韦酯治疗原发性肝癌的临床疗效明显优于单纯行TACE治疗者.     

肝动脉、门静脉双路化疗原发性肝癌(附68例报告)

目的　观察双路化疗 [经导管肝动脉化疗栓塞 (TACE)联合 B超引导下经皮经肝细针穿刺门静脉化疗 (PVE) ]治疗原发性肝细胞肝癌 (HCC)的疗效。方法　 HCC患者 6 8例进行 TACE+PVE,同期选择单纯行TACE患者 2 4例作为对照。结果　 TACE+PVE组和单纯 TACE组的总有效率 (完全缓解 +部分缓解 +无变化 )分别是 5 7.4%和 37.5 %,两组有显著性差异 (P<0 .0 1) ,门静脉癌栓消失 +缩小率两组分别是 5 5 .9%和 2 5 %(P<0 .0 5 )。 1、2、3年生存率 TACE组分别是 6 2 .5 %、37.5 %、2 0 .8%;TACE+PVE组分别是 91.2 %、6 1.8%、39.7%(P<0 .0 5 )。结论　 TACE+PVE治疗 HCC优于单纯 TACE;B超引导下细针穿刺门静脉行 PVE操作简便 ,并发症少 ,有临床推广价值。     

三维适形放疗联合TACE治疗大肝癌患者肿瘤标志物水平及3年生存观察

目的研究三维适形放疗(3-DCRT)联合经导管肝动脉化疗栓塞术(TACE)治疗大肝癌患者肿瘤标志物水平及3年生存情况。方法纳入2013年4月至2016年4月河南科技大学第一附属医院收治的146例原发性大肝癌患者为对象,按抽签随机方法分为两组,各73例,其中对照组予单纯TACE治疗,观察组予3-DCRT联合TACE治疗,均于治疗结束后3个月评估临床疗效。分析两组治疗前后血清甲胎蛋白(AFP)、α-L-岩藻糖苷酶(AFU)、糖类抗原19-9(CA19-9)水平,并观察两组远期生存率。结果观察组总有效率为76.71%,显著高于对照组的50.68%(P<0.05)。观察组治疗后AFP、AFU、CA19-9显著低于治疗前及对照组治疗后(P<0.05)。观察组治疗后6个月及1、2、3年生存率分别为93.15%、79.45%、61.64%、39.73%,显著高于对照组的69.86%、52.05%、32.88%、23.29%(P<0.05)。结论3-DCRT联合TACE治疗大肝癌安全可行,能有效降低血清肿瘤标志物水平,提高患者远期生存率。     

明胶海绵微粒TACE联合乌苯美司胶囊治疗肝癌的临床研究

目的观察新型明胶海绵微粒经导管肝动脉化疗栓塞术(TACE)联合乌苯美司胶囊治疗原发性肝癌的疗效。方法 2010年6～12月,我院应用新型明胶海绵微粒(350～560μm)行TACE联合乌苯美司胶囊治疗原发性肝癌患者25例,20例单纯行TACE治疗,观察两组生活质量变化、用药期间不良反应及疗效。结果随访6～12个月、平均10.6个月,实验组总缓解率(88%)及获益率(96%)均高于对照组(60%、75%),P<0.05。实验组患者生活质量改善有效率(92%)高于对照组(65%),P<0.05;行TACE次数(1.3±5.6)少于对照组(2.8±7.4),P<0.05。两组不良反应无统计学差异。结论明胶海绵微粒TACE治疗原发性肝癌疗效确切,联合乌苯美司胶囊有望进一步提高患者远期疗效。     

肝动脉化疗栓塞联合三维适形放疗治疗原发性肝癌40例

目的:探讨肝细胞性肝癌(HCC)的肝动脉化疗药物栓塞(TACE)联合三维适形放疗(3DCRT)的综合治疗效果.方法:原发性肝癌患者76例,进行前瞻性分组研究,综合治疗组40例行TACE结合3DCRT治疗,对照组36例单纯行TACE治疗.结果:综合治疗组1,2,3年生存率分别为78%,60%,34%;对照组分别为50%,32%,18%(P<0.05).结论:对不能手术切除治疗的原发性肝癌患者,TACE结合3DCRT治疗能明显提高治疗疗效,且无严重毒副作用.     

原发性肝癌根治术联合TACE术后肠道菌群变化特征观察

目的 观察原发性肝癌根治术联合经肝动脉化疗栓塞(TACE)术后患者肠道菌群的变化。方法 选择2020年1月—2023年1月西安交通大学第二附属医院收治的114例原发性肝癌患者,对照组(57例)接受肝癌根治术,观察组(57例)在肝癌根治术后联合TACE治疗。比较两组临床疗效,检测血清指标及乳杆菌、肠杆菌、酵母菌、双歧杆菌等菌群数量,相关性采用Pearson相关系数分析。结果 两组疾病控制率分别为94.74%、80.70%,观察组较高(P<0.05);治疗后观察组血清甲胎蛋白(AFP)、肿瘤坏死因子α(TNFα)、白细胞介素-6(IL-6)水平分别为(581.64±47.32)ng/mL、(85.13±15.37)pg/mL、(124.39±15.73)pg/mL,均明显低于对照组[分别为(662.37±52.49)ng/mL、(92.53±19.84)pg/mL、(145.81±19.77)pg/mL],白细胞介素-2(IL-2)水平为(86.22±5.84)pg/mL,明显高于对照组的(80.26±7.33)pg/mL(P<0.05)。治疗后观察组乳杆菌、双歧杆菌数量分别为...     

原发性肝癌根治性切除术后不同时间TACE对血清肿瘤标志物及复发风险的影响

目的 观察原发性肝癌根治术后不同时间肝动脉介入化疗栓塞术(TACE)对血清肿瘤标志物和复发风险的影响。方法 选取2016年3月—2019年10月亳州市中医院接受根治性切除术治疗的65例原发性肝癌患者，使用随机数字表法分为观察组(33例)和对照组(32例)。两组均在根治性切除术后进行TACE治疗，其中观察组术后4周进行TACE治疗，对照组术后8～12周进行TACE治疗，两组第1次TACE治疗后间隔4周后接受第2次治疗。比较两组术后并发症及随访3年肝内复发率。结果 治疗前，两组癌胚抗原(CEA)分别为(26.63±5.19)ng/mL、(25.48±4.03)ng/mL,两组甲胎蛋白(AFP)分别为(84.39±8.61)μg/L、(85.52±9.36)μg/L,两组糖类抗原199(CA199)分别为(81.06±7.93)U/L、(80.54±6.68)U/L,两组CEA、AFP、CA199无明显差异(P>0.05);治疗后，两组CEA分别为(4.13±0.72)ng/mL、(6.18±0.95)ng/mL,两组AFP分别为(16.28±3.65)μg/L、(24.97±5.14...     

三维适形放疗联合肝动脉化疗栓塞术对原发性肝癌患者临床疗效、生存率及γ-GT、AFP的影响

目的探讨三维适形放疗(3-DCRT)联合肝动脉化疗栓塞术(TACE)对原发性肝癌患者临床疗效、生存率及γ-GT、AFP的影响。方法按照随机数字表法将80例原发性肝癌患者均分为试验组和对照组,对照组患者给予TACE治疗,试验组患者在此基础上给予3-DCRT治疗,比较2组患者临床疗效和预后情况。结果试验组患者疗程结束后客观缓解率(ORR)明显高于对照组,差异具有统计学意义(P0.05);2组患者疗程结束后γ-GT、AFP水平变化情况比较,差异无统计学意义(P0.05);试验组患者1、2、3年生存率及中位生存时间均明显高于对照组,差异具有统计学意义(P0.05);肝内肿瘤进展是导致患者死亡的主要原因,转移是导致患者死亡的次要原因。结论在TACE基础上联用3-DCRT能够有效提高原发性肝癌近期疗效和远期生存率,但与单纯TACE比较,在γ-GT、AFP的影响上差异并无明显统计学意义。     

奥沙利铂联合表柔比星经肝动脉化疗栓塞治疗原发性肝癌的研究

目的:观察奥沙利铂联合表柔比星经肝动脉化疗栓塞(TACE)治疗原发性肝癌的效果及安全性。方法:80例原发性肝癌患者按随机数字表法分为对照组(单纯碘油TACE)和观察组(奥沙利铂联合表柔比星经TACE),对比两组患者治疗总有效率、1年生存率;比较两组患者术前、治疗3周、治疗6周血清甲胎蛋白(AFP)、癌胚抗原(CEA)水平;并对比两组患者不良反应发生率。结果:观察组患者总有效率(92.50%)较对照组(72.50%)高,1年生存率(75.00%)较对照组患者(60.00%)高;治疗3周时观察组患者CEA水平降低且低于对照组患者,治疗6周时观察组AFP、CEA均降低且低于对照组患者;观察组患者血小板减少率(10.00%)、白细胞减少率(22.50%)、中性粒细胞减少率(22.50%)均低于对照组。上述比较均有统计学差异,P均0.05。结论:奥沙利铂联合表柔比星-TACE能提高原发性肝癌患者治疗效果,降低肿瘤标志物水平,减少不良反应,提高1年生存率,值得临床应用。     

Individualized treatment models based on blood supply characteristics in hepatocellular carcinoma using color Doppler hemodynamics

BACKGROUND/AIMS: We evaluated the long-term efficacy of the combination of transcatheter arterial chemoembolization (TACE) using cisplatin-lipiodol suspension, transultrasonic portal vein chemoembolization (SPVE), radiofrequency ablation (RF), percutaneous ethanol injection (PEI) for treatment of advanced small hepatocellular carcinoma (HCC). METHODOLOGY: A total of three hundred and eighteen patients with HCC were enrolled in this study. According to the blood supply characteristics to the tumor, individual combined therapy models were adopted: one hundred and fifty-nine patients with HCC less than 5 cm were treated with a combination of RF and PEI (RF/PEI group) and one hundred and one patients with HCC greater than 5cm were treated with a combination of TACE, RF and PEI (TACE/RF/PEI group). One hundred and eleven HCC nodules confirmed to be hypervascular by color Doppler flow imaging were treated with a combination of TACE, RF, SPVE and PEI (TACE/ RF/SPVE/PEI group). RESULTS: The combination treatment of RF and PEI (RF/PEI group), the TACE/RF/PEI group, TACE/ RF/SPVE/PEI group, the 1-year survival rates and the 3-year survival rates were 97.3% and 82.4%; 73.5% and 44.9%; 74.1% and 37.9%, respectively; The vanishing rate of blood flow around and within the tumor, the tumor size decrease rate, AFP transformed to negative rate, were significantly raised compared to those in the TACE treatment only group. CONCLUSIONS: The individual combined therapy models combination of TACE, PEI, SPVE, RF appears to prolong survival, compared with one treatment alone (TACE). This combination therapy method is an effective way for treating HCC, and color Doppler can provide important information to verify the therapeutic effects.     

单纯肝动脉栓塞化疗或联合无水酒精注射治疗肝细胞癌疗效比较的Meta分析

目的评价肝动脉栓塞化疗（TACE）联合无水乙醇注射治疗肝细胞癌的疗效和安全性。方法检索PubMed、Cochrane图书馆、Embase、中国生物医学数据库和万方数据库至2012年12月的最新数据,收集所有TACE联合无水乙醇注射与单纯TACE治疗肝细胞癌患者的随机对照研究（RCT）。按照纳入和排除标准选择文献、提取资料和评价纳入研究的方法学质量后,采用RevMan 5.1进行Meta分析。结果在13个RCT共962例患者,显示TACE联合无水乙醇注射治疗1年、2年和3年生存率均较单纯TACE更优,其OR值分别为3.78（95%CI为2.79-5.12）、3.07（95%CI为2.27-4.17）和5.84（95%CI为2.86-11.93）;在其中6个RCT共294例患者,联合治疗患者血清甲胎蛋白下降至正常者显著优于单纯TACE治疗组（OR=4.0,95%CI为2.24-7.15）,但两组间AFP下降（≥25%）而未达正常者无明显差异（OR=1.24,95%CI为0.68-2.27）;两组均未出现严重的不良反应。结论 TACE联合无水乙醇注射治疗患者生存率及AFP下降至正常均优于单纯TACE治疗,患者的生存率明显提高,无严重的不良反应。     

Outcome of transarterial chemoembolization monotherapy, and in combination with percutaneous ethanol injection, or radiofrequency ablation therapy for hepatocellular carcinoma

Aim:  Hepatocellular carcinoma (HCC) is one of the most commonly occurring malignances worldwide. Curative therapies such as resection, percutaneous ethanol injection (PEI) and radiofrequency ablation (RFA) have been applied to patients with early-stage HCC. Patients with more advanced cancers require local or systemic therapies. We present the results of our retrospective review conducted to evaluate whether transarterial chemoembolization (TACE) alone and combined TACE with percutaneous ablation for HCC exhibited superior efficacy to palliative treatment.
Methods:  The effects of TACE and of the combined therapies (TACE + PEI or TACE + RFA) on the long-term survival rates were evaluated in 268 untreated HCC patients by various statistical analyses.
Results:  The cumulative survival rates in the TACE alone group were significantly superior to those in the palliative treatment group. Further, the cumulative survival rates in the combined TACE + PEI/RFA group were significantly superior to those in the TACE alone group. When the comparison among the groups was restricted to patients with two or three tumors fulfilling the Milan criteria, significantly greater prolongation of survival was observed in the combined TACE + PEI/RFA group than in the PEI/RFA alone group.
Conclusions:  The aforementioned treatment modalities yielded greater improvements of the survival rate and survival duration as compared to palliative treatment in HCC patients. Furthermore, in terms of the effect on the survival period, combined TACE + PEI/RFA therapy was more effective than TACE monotherapy, and also more effective than PEI or RFA monotherapy in cases with multiple tumors fulfilling the Milan criteria.     

联合治疗复发性肝癌血液循环性肝癌细胞的变化及意义

目的：探讨联合经肝动脉插管化疗栓塞术（TACE）及无水酒精瘤内注射术（EPI）治疗复发性肝癌周围静脉血液循环性肝癌细胞的变化及其意义,方法：应用巢式RT－PCR检测19例复发性肝癌患者而血液循环性肝癌细胞,并经TACE及PEI联合治疗观察其血液循环性肝癌细胞的变化。结果：血液循环性肝癌细胞表达阳性的7例复发性肝癌患者（36．8％）,经TACE及PEI联合治疗后其血液循环性肝癌细胞均转有阴性（100％,,0．01）.结论：联合TACE及PEI治疗复发性肝癌可有效地杀灭血液中播散的循环性肝癌细胞,可预防肝癌再复发和转移的发生。     

肝动脉化疗栓塞及注射32P-胶体、无水乙醇综合序贯介入治疗原发性肝癌疗效分析

目的 评价肝动脉化疗栓塞及Ｂ超引导下注射＾３２Ｐ－胶体、无水乙醇（ＰＥＩ）综合序贯介入治疗原发性肝癌的临床价值。方法 ５１例中晚期肝癌分为２组,２３例综合序贯应用ＴＡＣＥ＋＾３２Ｐ＋ＰＥＩ治疗,２８例单纯应用ＴＡＱＣＥ治疗。结果 综合序贯组肿瘤缩小率、肿瘤完全坏死率、ＡＦＰ下降率分别为９１．２９％、８０．００％、８７．５％,而单纯ＴＡＣＥ组分别为３９．２７％、３０．４３％、４１．４６％,两组比较有     

Combination of repeated single-session percutaneous ethanol injection and transarterial chemoembolisation compared to repeated single-session percutaneous ethanol injection in patients with non-resectable hepatocellular carcinoma

AIM: To evaluate the treatment effect of percutaneous ethanol injection (PEI) for patients with advanced, non-resectable HCC compared with combination of transarterial chemoembolisation (TACE) and repeated single-session PEI, repeated single-session PEI alone, repeated TACE alone, or best supportive care. METHODS: All patients who received PEI treatment during the study period were included and stratified to one of the following treatment modalities according to physical status and tumor extent: combination of TACE and repeated single-session PEI, repeated single-session PEI alone, repeated TACE alone, or best supportive care. Prognostic value of clinical parameters including Okuda-classification, presence of portal vein thrombosis, presence of ascites, number of tumors, maximum tumor diameter, and serum cholinesterase (CHE), as well as Child-Pugh stage, a-fetoprotein (AFP), fever, incidence of complications were assessed and compared between the groups. Survival was determined using Kaplan-Meier and multivariate regression analyses. RESULTS: The 1- and 3-year survival of all patients was 73% and 47%. In the subgroup analyses, the combination of TACE and PEI (1) was associated with a longer survival (1-, 3-, 5-year survival: 90%, 52%, and 43%) compared to PEI treatment alone (2) (1-, 3-, 5-year survival: 65%, 50%, and 37%). Secondary PEI after initial stratification to TACE (3) yielded comparable results (1-, 3-, 5-year survival: 91%, 40%, and 30%) while PEI after stratification to best supportive care (4) was associated with decreased survival (1-, 3-, 5-year survival: 50%, 23%, 12%). Apart from the chosen treatment modalities, predictors for better survival were tumor number (n < 5), tumor size (< 5 cm), no ascites before PEI, and stable serum cholinesterase after PEI (P < 0.05). The mortality within 2 wk after PEI was 2.8% (n = 3). There were 24 (8.9%) major complications after PEI including segmental liver infarction, focal liver necrosis, and liver abscess. All complications could be managed non-surgically. CONCLUSION: Repeated single-session PEI is effective in patients with advanced HCC at an acceptable and manageable complication rate. Patients stratified to a combination of TACE and PEI can expect longer survival than those stratified to repeated PEI alone. Furthermore, patients with large or multiple tumors in good clinical status may also profit from a combination of TACE and reconsideration for secondary PEI.     

体部伽玛刀与三维适形放射治疗原发性肝癌临床疗效比较

目的比较肝动脉介入栓塞化疗(TACE)联合伽玛刀治疗与TACE联合三维适形放射治疗原发性肝癌(HCC)的疗效。方法将50例不能手术的Ⅱa或Ⅱb期HCC患者根据患者意愿和适应证分为TACE+伽玛刀治疗组(A组)25例与TACE+三维适形放射治疗组(B组)25例,两组一般情况无统计学差异。A组先行TACE(40%碘化油+CPDD+5-FU+EADM)治疗2～3次后,再进行体部伽玛刀放射治疗。B组先行2～3次TACE治疗后,再行加速器适形放射治疗。结果治疗后3个月评价疗效,A组RR率(CR+PR)为84%(21/25),1、2、3年生存率分别为76%,45.9%,20.44%。B组的RR率为56%(14/25),与A组比较差异有统计学意义(P<0.05),B组1、2、3年生存率分别为79.6%,30.2%,12.6%,与A组比较差异无统计学意义(P>0.05)。结论与TACE联合适形放射治疗相比,TACE联合伽玛刀治疗HCC具有较高的近期有效率,而两种治疗的1、2、3年生存期差异无统计学意义。     

介入治疗结合大分割三维适形放射治疗原发性肝癌的疗效评价

目的　评价肝动脉化疗栓塞 (TACE)结合大分割三维适形放射治疗 (3 DCRT)肝细胞癌(HCC)的疗效。方法　 1 998年 5月至 1 999年 1 2月 ,81例不能手术切除的HCC患者 ,采用非随机分组方法 ,综合治疗组 4 1例采用TACE结合大分割 3 DCRT ,对照组 4 0例单独行TACE治疗 ,观察近期疗效 ,生存分析用Kaplan Meier法 ,两组生存率比较采用Log rank检验 ,综合治疗组多因素分析采用Cox比例风险模型。结果　综合治疗组和对照组肿瘤缓解率分别为 85 .4 %和 6 5 .0 % (P <0 .0 5 ) ,1、2、3年生存率分别为 90 .2 %、75 .6 %、4 4 .6 %和 89.7%、5 8.7%、2 4 .0 % ,两组生存率比较差异有显著性 (P=0 .0 4 39)。两组中位生存期分别为 36和 2 7个月。综合治疗组中 ,Child分级、临床分期及肿瘤直径是影响预后的主要因素 (P <0 .0 5 )。结论　综合治疗组较对照组有较好的疗效。综合治疗组中Child分级、临床分期、肿瘤直径对患者的预后有重要影响     

Percutaneous ethanol injection, radiofrequency and their combination in treatment of hepatocellular carcinoma

AIM: To evaluate the therapeutic effect and the indication of percutaneous ethanol injection (PEI),radiofrequency ablation (RFA) and their combination in treatment of hepatocellular carcinoma (HCC).METHODS: Two hundred and fifty-five patients with HCC received treatment of PEI, RFA or their combination.Group1 (＜ 3 cm in diameter, n=85) was treated with PEI,group2 (＜ 3 cm in diameter, n=153) with RFA. Group3(＞3 cm in diameter, n=86) was divided into two groups.Group 3a (n=34) was treated with RFA, while group 3b(n=52) was treated with RFA for 2 wk after transcatheter arterial chemoembolization or PEI. Contrast-enhanced sonography was performed for 61 patients before and after RFA. Liver function and serum alpha-fetoprotein (AFP) were measured for all patients. Changes of the lesions on ultrasound and contrast-enhanced CT/MRI were evaluated for assessing the therapeutic responses.The 1-, 2-, 3- and 5-year survival rates were recorded after treatment.RESULTS: In group 1, the complete necrosis rate of lesions after 1 mo was 77.6% (66/85). The level of AFP declined conspicuously after 1 mo. The 1-, 2-, 3- and 5-year survival rate after treatment was 80.0% (52/65),60.4% (32/53), 52.5% (21/40) and 33.3% (7/21),respectively. In group 2, the complete necrosis rate of lesions after 1 moh was 92.2% (141/153). The level of AFP decreased conspicuously after 1 mo. The 1-, 2-,3- and 5-year survival rate after treatment was 94.6%(88/93), 73.2% (52/71), 63.5% (33/52) and 46.4%(13/28), respectively. In group 3a, the complete necrosis rate of lesions after 1 mo was 23.5% (8/34). AFP dropped down to the normal level in only one patient after 1 mo. The 1-, 2- and 3-year survival rate after treatment was 47.6% (10/21), 42.9% (6/14) and 27.3%(3/11), respectively. Only one patient was still alive after 5 years. In group 3b, the complete necrosis rate of lesions after 1 mo was 57.7% (30/52). The level of AFP decreased after 1 mo. The 1-, 2-, 3- and 5-year survival rate after treatment was 68.6% (24/35), 46.2% (12/26),36.8% (7/19) and 27.3% (3/11), respectively.CONCLUSION: The therapeutic effect of RFA on small HCC is better than that of PEI. Small HCC is the optimal indication of RFA. For recurrent HCC (diameter＞3 cm),the combined treatment of RFA and PEI/ACE should be used.