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Mukund A, Ramalingam R, Anandpara KM, Patidar Y, Vijayaraghavan R, Sarin SK. Efficacy and safety of percutaneous microwave ablation for hepatocellular carcinomas <4 cm in difficult location. Br J Radiol 2020; 93:20191025. [PMID: 32970472 PMCID: PMC7716003 DOI: 10.1259/bjr.20191025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 09/09/2020] [Accepted: 09/14/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Tumor location is a critical factor for determining technical success and local recurrence following percutaneous ablation of hepatocellular carcinomas (HCC). The purpose of this retrospective study was to evaluate the safety and outcome measures of percutaneous microwave ablation (pMWA) for HCCs <4 cm in difficult locations. METHODS Retrospective review included 81 patients who underwent pMWA for HCCs <4 cm. Fourty-three patients (30 males and 13 females; mean age, 61 years) with 53 HCCs located near the diaphragm, heart, gallbladder, kidney, gastrointestinal tract, large vessel and exophytic location were included under difficult location group. Thirty-eight patients (29 males and nine females; mean age, 60 years) with 48 HCCs in other locations were included under control group. Baseline demographics were recorded. Technical efficacy, local tumor progression (LTP), and complication rates were evaluated. RESULTS Mean follow-up period was 3.4 months (range 1-7). There was no major complication in both the groups; two patients had a mild perihepatic hemorrhage in the difficult location group which was managed conservatively. There was no difference between the groups in the overall technical efficacy rate (84.9% vs 91.7%, p = 0.294), LTP rate (4.4% vs 2.2%. p = 0.57) or complication rate (4.6% vs 0%, p = 0.177). CONCLUSION Our data suggest that there is no significant difference in technical efficacy, LTP or complication rates for MWA in both difficult and normal locations. ADVANCES IN KNOWLEDGE With proper patient selection, pre-procedural planning and appropriate technique, pMWA is feasible, safe, and effective for small HCCs in difficult location with an acceptable range of complications.
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Affiliation(s)
- Amar Mukund
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Ravindran Ramalingam
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Karan Manoj Anandpara
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Yashwant Patidar
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Rajan Vijayaraghavan
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
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Chen S, Peng Z, Lin M, Chen Z, Hu W, Xie X, Liu L, Qian G, Peng B, Li B, Kuang M. Combined percutaneous radiofrequency ablation and ethanol injection versus hepatic resection for 2.1–5.0 cm solitary hepatocellular carcinoma: a retrospective comparative multicentre study. Eur Radiol 2018; 28:3651-3660. [DOI: 10.1007/s00330-018-5371-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 02/01/2018] [Accepted: 02/06/2018] [Indexed: 12/17/2022]
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Meng LMD, Zhiyan LMD, Yuejuan GMD, Jiangke TMD, Min CMD, Jinghui DMD. Safety and Efficacy of Percutaneous Radiofrequency Ablation Combined with Percutaneous Ethanol Injection for Hepatocellular Carcinoma in High-risk Locations. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2018. [DOI: 10.37015/audt.2018.180004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Chen S, Peng Z, Xiao H, Lin M, Chen Z, Jiang C, Hu W, Xie X, Liu L, Peng B, Kuang M. Combined radiofrequency ablation and ethanol injection versus repeat hepatectomy for elderly patients with recurrent hepatocellular carcinoma after initial hepatic surgery. Int J Hyperthermia 2017; 34:1029-1037. [PMID: 28974113 DOI: 10.1080/02656736.2017.1387941] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To retrospectively compare the efficacy and safety of combined radiofrequency ablation and percutaneous ethanol injection (RFA-PEI) with repeat hepatectomy for elderly patients with initial recurrent hepatocellular carcinoma (HCC) after hepatic surgery. METHODS From January 2009 to June 2015, 105 elderly patients (≥70 years) who underwent RFA-PEI (n = 57) or repeated hepatectomy (n = 48) for recurrent HCC ≤ 5.0 cm were included in the study. The overall survival (OS) and recurrence-free survival (RFS) were analysed with the Kaplan-Meier method and compared by the log-rank test. Non-tumour-related death, complications and hospital stays were assessed. Univariate and multivariate analyses were performed to identify the prognostic significance of the variables in predicting the OS and RFS. RESULTS OS rates were 78.2%, 40.8% and 36.7% at 1, 3 and 5 years after RFA-PEI and 76.3%, 52.5% and 42.6% after repeat hepatectomy, respectively (p = 0.413). Correspondingly, the 1-, 3- and 5-year RFS rates after RFA-PEI and repeat hepatectomy were 69.5%, 37.8%, 33.1% and 73.1%, 49.7%, 40.7%, respectively (p = 0.465). Non-tumour-related deaths in the RFA-PEI group (2/57) were significantly fewer than those in the repeat hepatectomy group (10/48) (p = 0.016). RFA-PEI was superior to repeat hepatectomy regarding the major complication rates and length of in-hospital stay (both p < 0.001). Multivariate analysis showed that the tumour number was the significant prognostic factor for the OS (hazard ratio (HR) = 1.961, 95% CI = 1.043-3.686, p = 0.037) and RFS (HR = 1.866, 95% CI = 1.064-3.274, p = 0.030). CONCLUSION RFA-PEI provides comparable OS and RFS to repeat hepatectomy for elderly patients with small recurrent HCC after hepatectomy but with fewer non-tumour-related deaths, major complications and shorter hospital stays.
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Affiliation(s)
- Shuling Chen
- a Division of Interventional Ultrasound , The First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Zhenwei Peng
- b Department of Oncology , The First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China.,c Department of Clinical Trial Unit , The First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Han Xiao
- d Department of Gastroenterology , The First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Manxia Lin
- a Division of Interventional Ultrasound , The First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Zebin Chen
- e Department of Liver Surgery , The First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Chunlin Jiang
- a Division of Interventional Ultrasound , The First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Wenjie Hu
- e Department of Liver Surgery , The First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Xiaoyan Xie
- a Division of Interventional Ultrasound , The First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Longzhong Liu
- f Department of Ultrasonic , Sun Yat-sen University Cancer Centre , Guangzhou , China
| | - Baogang Peng
- e Department of Liver Surgery , The First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Ming Kuang
- a Division of Interventional Ultrasound , The First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China.,e Department of Liver Surgery , The First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
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Li Z, Zhang K, Lin SM, Mi DH, Cao N, Wen ZZ, Li ZX. Radiofrequency ablation combined with percutaneous ethanol injection for hepatocellular carcinoma: a systematic review and meta-analysis. Int J Hyperthermia 2016; 33:237-246. [PMID: 27701918 DOI: 10.1080/02656736.2016.1237681] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Zheng Li
- Department of General Surgery, First Clinical Medical College of Lanzhou University, Lanzhou, Gansu Province, PR China
- Department of Oncology, Second People's Hospital of Gansu Province, Lanzhou, Gansu Province, PR China
| | - Kai Zhang
- Department of Infectious Disease, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, PR China
| | - Shu-Mei Lin
- Department of Infectious Disease, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, PR China
| | - Deng-Hai Mi
- Department of General Surgery, First Clinical Medical College of Lanzhou University, Lanzhou, Gansu Province, PR China
- Department of Oncology, Second People's Hospital of Gansu Province, Lanzhou, Gansu Province, PR China
| | - Nong Cao
- Department of General Surgery, First Clinical Medical College of Lanzhou University, Lanzhou, Gansu Province, PR China
| | - Zhi-Zhen Wen
- Department of Oncology, Second People's Hospital of Gansu Province, Lanzhou, Gansu Province, PR China
| | - Zhong-Xin Li
- Department of Oncology, Second People's Hospital of Gansu Province, Lanzhou, Gansu Province, PR China
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Shi F, Tan Z, An H, Wang X, Xu Y, Wang S. Hepatocellular carcinoma ≤ 4 cm treated with radiofrequency ablation with or without percutaneous ethanol injection. Ann Hepatol 2016; 15:61-70. [PMID: 26626642 DOI: 10.5604/16652681.1184219] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND To compare the survival of Chinese cirrhotic patients with hepatocellular carcinoma (HCC) ≤ 4 cm who underwent radiofrequency ablation (RFA) alone or a combination of RFA with percutaneous ethanol injection (PEI). MATERIAL AND METHODS Retrospective analysis was performed for 681 cases with HCC ≤ 4 cm who were treated with RFA alone or RFA combined with PEI (RFA + PEI) between 2004 and 2011. RESULTS As a result, 180 patients in each group were selected after propensity score matching (PSM). Higher overall survival (OS) and recurrence-free survival (RFS) rates were achieved by RFA + PEI compared with RFA alone (P = 0.019 and 0.009, respectively). The 1-, 3-, and 5-year cumulative OS rates were 78.0, 44.4, and 30.1% for patients in RFA group and 88.2, 58.0, and 41.1% for patients in RFA + PEI group, respectively. Besides, the 1-, 3-, and 5-year cumulative RFS rates were 77.0, 43.8, and 29.2% in RFA group, and 87.9, 57.6, and 38.4% in RFA + PEI group, respectively. The local recurrence, complete ablation and five-year mortality showed no distinct differences between RFA and RFA + PEI groups in three subgroups classified with tumor size. Moreover, Cox regression multivariate analysis results showed that sex and treatment approach were significantly related to OS, whereas sex, status of HBsAg, local recurrence, and number of tumor nodule were related to RFS. CONCLUSION Therefore, the combination of RFA and PEI yielded better OS and RFS rates than RFA alone for Chinese patients with HCC ≤ 4 cm.
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Affiliation(s)
- Fuyan Shi
- Department of Health Statistics, School of Public Health, Weifang Medical College, Weifang, Shandong, China
| | - Zhijun Tan
- Department of Health Statistics, School of Military Preventive Medicine, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Hongqing An
- Department of Mathematics, School of Public Health, Weifang Medical College, Weifang, Shandong, China
| | - Xiaoli Wang
- Department of Operating Room, Tumor Hospital, Jinan, Shandong, China
| | - Yongyong Xu
- Department of Health Statistics, School of Military Preventive Medicine, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Suzhen Wang
- Department of Health Statistics, School of Public Health, Weifang Medical College, Weifang, Shandong, China
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Li M, Li Z, Yu X, Liang P, Gao Y, Han Z, Liu F, Dong J. Percutaneous radio-frequency ablation of hepatocellular carcinoma adjacent to the gastrointestinal tract. Int J Hyperthermia 2016; 32:600-6. [PMID: 27112031 DOI: 10.3109/02656736.2016.1157904] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Meng Li
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
- Department of Ultrasound, Beijing 302 Hospital, Beijing, China
| | - Zhiyan Li
- Department of Ultrasound, Beijing 302 Hospital, Beijing, China
| | - Xiaoling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Yuejuan Gao
- Department of Ultrasound, Beijing 302 Hospital, Beijing, China
| | - Zhiyu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Fangyi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Jinghui Dong
- Department of Radiology, Beijing 302 Hospital, Beijing, China
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Chen L, Sun J, Yang X. Radiofrequency ablation-combined multimodel therapies for hepatocellular carcinoma: Current status. Cancer Lett 2015; 370:78-84. [PMID: 26472630 DOI: 10.1016/j.canlet.2015.09.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 09/13/2015] [Accepted: 09/23/2015] [Indexed: 12/21/2022]
Abstract
Radiofrequency ablation (RFA) is widely accepted as a first-line interventional oncology approach for hepatocellular carcinoma (HCC) and has the advantages of high treatment efficacy and low complication risk. Local control rates equivalent to hepatic resection can be reached by RFA alone when treating small HCCs (<2 cm) in favorable locations. However, local tumor progression and recurrence rates with RFA monotherapy increase sharply when treating larger lesions (>3 cm). To address this clinical problem, recent efforts have focused on multimodel management of HCC by combining RFA with different techniques, including percutaneous ethanol injection, transarterial chemo-embolization, targeted molecular therapy, nanoparticle-mediated therapy, and immunotherapy. The combination strategy indeed leads to better outcomes in comparison to RFA alone. In this article, we review the current status of RFA-combined multimodal therapies in the management of HCC.
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Affiliation(s)
- Lumin Chen
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jihong Sun
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoming Yang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China; Image-Guided Bio-Molecular Interventions Research, Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA.
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Li M, Yu X, Liang P, Dong B, Liu F. Ultrasound-guided percutaneous microwave ablation for hepatic malignancy adjacent to the gallbladder. Int J Hyperthermia 2015; 31:579-87. [DOI: 10.3109/02656736.2015.1014869] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Catalano O, Izzo F, Vallone P, Sandomenico F, Albino V, Nunziata A, Fusco R, Petrillo A. Integrating contrast-enhanced sonography in the follow-up algorithm of hepatocellular carcinoma treated with radiofrequency ablation: single cancer center experience. Acta Radiol 2015; 56:133-42. [PMID: 24523360 DOI: 10.1177/0284185114521108] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) patients treated with percutaneous ablation require close follow-up for early detecting and treating tumor recurrence. PURPOSE To illustrate our single-center prospective experience on using contrast-enhanced ultrasound (CEUS) as a follow-up tool alternated with computed tomography (CT). MATERIAL AND METHODS In a 7-year period 588 patients with one to three HCCs were treated with radiofrequency ablation (alone or combined with ethanol injection). Patients with completely ablated tumors at 1-month CT scan were followed up serially, using alternated CEUS (one microbubbles injection per lobe) and CT every 3 months for 2 years. In few cases magnetic resonance imaging (MRI) was employed instead of or in addition to CT. The following patterns of recurrence were considered: A, enhancing tissue within the lesion; B, enhancing tissue adherent to the lesion; C, enhancing tissue within the same liver segment of the treated nodule; and D, enhancing tissue within a different segment. Patients with positive CEUS underwent confirmatory CT/MRI (standard reference). RESULTS Median follow-up was 19 months. There were 221 recurrences. Three pattern A recurrences (2 detected by CEUS and 1 by CT), 86 pattern B recurrences (44 detected by CEUS and 42 by CT), 70 pattern C recurrences (32 detected by CEUS and 38 by CT), and 62 pattern D recurrences (23 detected by CEUS and 39 by CT). CT detected additional nodules in 16/101 patients with positive CEUS. CONCLUSION CEUS follow-up of HCC patients after ablation is feasible. Since 72% recurrences develop in the same segment of the necrotic nodule, CEUS proves to be effective despite the minor visualization of the entire liver during the arterial phase when compared to CT and MRI. Including CEUS in patient follow-up may reduce the number of CT and MRI examinations.
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Affiliation(s)
- Orlando Catalano
- Department of Radiology, Istituto Nazionale Tumori, IRCCS Fondazione Pascale, Naples, Italy
| | - Francesco Izzo
- Department of Hepatobiliary Surgery, Istituto Nazionale Tumori, IRCCS Fondazione Pascale, Naples, Italy
| | - Paolo Vallone
- Department of Radiology, Istituto Nazionale Tumori, IRCCS Fondazione Pascale, Naples, Italy
| | - Fabio Sandomenico
- Department of Radiology, Istituto Nazionale Tumori, IRCCS Fondazione Pascale, Naples, Italy
| | - Vittorio Albino
- Department of Hepatobiliary Surgery, Istituto Nazionale Tumori, IRCCS Fondazione Pascale, Naples, Italy
| | | | - Roberta Fusco
- Department of Radiology, Istituto Nazionale Tumori, IRCCS Fondazione Pascale, Naples, Italy
| | - Antonella Petrillo
- Department of Radiology, Istituto Nazionale Tumori, IRCCS Fondazione Pascale, Naples, Italy
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Hoang NH, Murad HY, Ratnayaka SH, Chen C, Khismatullin DB. Synergistic ablation of liver tissue and liver cancer cells with high-intensity focused ultrasound and ethanol. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:1869-1881. [PMID: 24798386 DOI: 10.1016/j.ultrasmedbio.2014.02.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 02/03/2014] [Accepted: 02/20/2014] [Indexed: 06/03/2023]
Abstract
We investigated the combined effect of ethanol and high-intensity focused ultrasound (HIFU), first, on heating and cavitation bubble activity in tissue-mimicking phantoms and porcine liver tissues and, second, on the viability of HepG2 liver cancer cells. Phantoms or porcine tissues were injected with ethanol and then subjected to HIFU at acoustic power ranging from 1.2 to 20.5 W (HIFU levels 1-7). Cavitation events and the temperature around the focal zone were measured with a passive cavitation detector and embedded type K thermocouples, respectively. HepG2 cells were subjected to 4% ethanol solution in growth medium (v/v) just before the cells were exposed to HIFU at 2.7, 8.7 or 12.0 W for 30 s. Cell viability was measured 2, 24 and 72 h post-treatment. The results indicate that ethanol and HIFU have a synergistic effect on liver cancer ablation as manifested by greater temperature rise and lesion volume in liver tissues and reduced viability of liver cancer cells. This effect is likely caused by reduction of the cavitation threshold in the presence of ethanol and the increased rate of ethanol diffusion through the cell membrane caused by HIFU-induced streaming, sonoporation and heating.
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Affiliation(s)
- Nguyen H Hoang
- Department of Biomedical Engineering, Tulane University, New Orleans, Louisiana, USA
| | - Hakm Y Murad
- Department of Biomedical Engineering, Tulane University, New Orleans, Louisiana, USA
| | - Sithira H Ratnayaka
- Department of Biomedical Engineering, Tulane University, New Orleans, Louisiana, USA
| | - Chong Chen
- Department of Biomedical Engineering, Tulane University, New Orleans, Louisiana, USA
| | - Damir B Khismatullin
- Department of Biomedical Engineering, Tulane University, New Orleans, Louisiana, USA.
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Sun YX, Cheng W, Han X, Liu Z, Wang QC, Shao H. In Vivo Experimental Study on the Effects of Fluid in Increasing the Efficiency of Radiofrequency Ablation. Asian Pac J Cancer Prev 2014; 15:5799-804. [DOI: 10.7314/apjcp.2014.15.14.5799] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Combining radiofrequency ablation and ethanol injection may achieve comparable long-term outcomes in larger hepatocellular carcinoma (3.1-4 cm) and in high-risk locations. Kaohsiung J Med Sci 2014; 30:396-401. [PMID: 25002377 DOI: 10.1016/j.kjms.2014.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 04/08/2014] [Accepted: 04/23/2014] [Indexed: 01/20/2023] Open
Abstract
Radiofrequency ablation (RFA) is more effective for hepatocellular carcinoma (HCC) < 3 cm. Combining percutaneous ethanol injection and RFA for HCC can increase ablation; however, the long-term outcome remains unknown. The aim of this study was to compare long-term outcomes between patients with HCC of 2-3 cm versus 3.1-4 cm and in high-risk versus non-high-risk locations after combination therapy. The primary endpoint was overall survival and the secondary endpoint was local tumor progression (LTP). Fifty-four consecutive patients with 72 tumors were enrolled. Twenty-two (30.6%) tumors and 60 (83.3%) tumors were of 3.1-4 cm and in high-risk locations, respectively. Primary technique effectiveness was comparable between HCC of 2-3 cm versus 3.1-4 cm (98% vs. 95.5%, p = 0.521), and HCC in non-high risk and high-risk locations (100% vs. 96.7%, p = 1.000). The cumulative survival rates at 1 year, 3 years, and 5 years were 90.3%, 78.9%, and 60.3%, respectively, in patients with HCC of 2-3 cm; 95.0%, 84.4%, and 69.3% in HCC of 3.1-4.0 cm (p = 0.397); 90.0%, 71.1%, and 71.1% in patients with HCC in non-high-risk locations; and 92.7%, 81.6%, and 65.4% in high-risk locations (p = 0.979). The cumulative LTP rates at 1 year, 3 years, and 5 years were 10.2%, 32.6%, and 32.6%, respectively, in all HCCs; 12.6%, 33.9%, and 33.9% in HCC of 2-3 cm; 4.8%, 29.5%, and 29.5% in HCC of 3.1-4 cm (p = 0.616); 16.7%, 50.0%, and 50.0% in patients with HCC in non-high-risk locations; and 8.8%, 29.9%, and 29.9% in patients with HCC in high-risk locations (p = 0.283). The cumulative survival and LTP rates were not significantly different among the various subgroups. Combining RFA and percutaneous ethanol injection achieved comparable long-term outcomes in HCCs of 2-3 cm versus 3.1-4.0 cm and in high-risk versus non-high-risk locations. A randomized controlled or cohort studies with larger sample size are warranted.
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Premachandran S, Khan NM, Thakur VS, Shukla J, Poduval TB. Differential immunotoxic effects of ethanol on murine EL-4 lymphoma and normal lymphocytes is mediated through increased ROS production and activation of p38MAPK. Immunopharmacol Immunotoxicol 2012; 34:616-26. [PMID: 22211272 DOI: 10.3109/08923973.2011.643313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Ethanol has been used to achieve thymic depletion in myasthenia gravis patients. Ethanol (95%) has also been used widely in the therapy of many tumors including hepatocellular carcinoma. In light of these findings, we delineated the differential immunotoxic behavior and mechanism of lower concentration of ethanol towards murine EL-4 lymphoma and its normal counterpart lymphocytes. EL-4 lymphoma and normal lymphocytes were cultured with ethanol (0%-5%) for 6 h and cytotoxicity was measured by various methods. EL-4 cells treated with ethanol showed concentration-dependent loss of viability at 2%-5% ethanol concentration and exhibit proliferative arrest at preG1 stage. Acridine-orange and ethidium-bromide staining indicated that ethanol induced death in EL-4 cells, by induction of both apoptosis and necrosis which was further supported by findings of DNA-fragmentation and trypan blue dye exclusion test. However, treatment of lymphocytes with similar concentration of ethanol did not show any death-associated parameters. Furthermore, ethanol induced significantly higher ROS generation in EL-4 cells as compared to lymphocytes and caused PARP cleavage and activation of apoptotic proteins like p53 and Bax, in EL-4 cells and not in normal lymphocytes. In addition, ethanol exposure to EL-4 cells led to phosphorylation of p38MAPK, and upregulation of death receptor Fas (CD95). Taken together, these results suggest that ethanol upto a concentration of 5% caused no significant immunotoxicity towards normal lymphocytes and induced cell death in EL-4 cells via phosphorylation of p38MAPK and regulation of p53 leading to further activation of both extrinsic (Fas) and intrinsic (Bax) apoptotic markers.
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Affiliation(s)
- Sudha Premachandran
- Immunology and Hyperthermia Section, Radiation Biology and Health Sciences Division, Bhabha Atomic Research Centre, Trombay, Mumbai-400085, India
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Azab M, Zaki S, El-Shetey AG, Abdel-Moty MF, Alnoomani NMG, Gomaa AA, Abdel-Fatah S, Mohiy S, Atia F. Radiofrequency ablation combined with percutaneous ethanol injection in patients with hepatocellular carcinoma. Arab J Gastroenterol 2011; 12:113-8. [PMID: 22055587 DOI: 10.1016/j.ajg.2011.07.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 04/05/2011] [Accepted: 07/13/2011] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND STUDY AIMS Hepatocellular 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 METHODS This 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. RESULTS After 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. CONCLUSION Combined treatment is superior to RFA alone and to PEI alone, in safety and efficacy in patients with HCC.
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Affiliation(s)
- Mohamed Azab
- Department of Tropical Medicine, Al-Azhar University, Cairo, Egypt
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Ji Q, Xu Z, Liu G, Lin M, Kuang M, Lu M. Preinjected fluids do not benefit microwave ablation as those in radiofrequency ablation. Acad Radiol 2011; 18:1151-8. [PMID: 21704535 DOI: 10.1016/j.acra.2011.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 04/25/2011] [Accepted: 05/19/2011] [Indexed: 02/08/2023]
Abstract
RATIONALE AND OBJECTIVES To detect whether the efficacy of microwave ablation (MWA) could be improved by preinjected fluids in an ex vivo porcine liver model. MATERIALS AND METHODS Ablations were performed for 12 minutes using energy output of impedance-based (power output gradually rose to 200W, maintained until increases in tissue impedance of 20 Ω, reduced to 10W, and switched on again 15 seconds later) in radiofrequency ablation (RFA) or 80 W in MWA. Before ablation, 5 mL of ethanol, distilled water, 0.9% NaCl solution, or 10% NaCl solution (n = 6 each) was injected into the targeted liver tissue. Ablations without fluid injection served as control. The ablation diameter, volume, shape index, and temperature were recorded and compared. RESULTS Preinjection of 0.9% or 10% NaCl solution resulted in larger coagulation volumes than that of the control group in RFA experiments (28.1 ± 2.9 cm(3), 45.3 ± 6.3 cm(3), 20.0 ± 2.5 cm(3), respectively; P < .05). Ethanol and distilled water had no impact on coagulation volumes in RFA. Preinjection of ethanol or 10% NaCl solution created smaller coagulation volumes than that of the control group in MWA experiments (34.3 ± 2.0 cm(3), 33.9 ± 4.1 cm(3), 58.0 ± 6.6 cm(3), respectively; P < .001). 0.9% NaCl solution and distilled water had no impact on coagulation volumes in MWA. CONCLUSION In an ex vivo porcine liver, preinjected fluids do not benefit microwave ablation as those in radiofrequency ablation.
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Radiofrequency ablation of large size liver tumours using novel plan-parallel expandable bipolar electrodes: initial clinical experience. Eur J Radiol 2009; 77:167-71. [PMID: 19616911 DOI: 10.1016/j.ejrad.2009.06.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2009] [Accepted: 06/22/2009] [Indexed: 02/06/2023]
Abstract
PURPOSE Although radiofrequency ablation (RFA) is a promising method for local treatment of liver malignancies, with conventional monopolar systems recurrence rates for large size tumours (≥3.5 cm) remain high. The objective of this study was to evaluate the safety, feasibility and local effectiveness of a novel bipolar plan-parallel expandable system for these larger tumours. METHODS AND MATERIALS Eight consecutive patients with either unresectable colorectal liver metastases (CRLM in 6 patients), carcinoid liver metastases (1 patient) and hepatocellular carcinoma (HCC in 1 patient) of ≥3.5 cm were treated with bipolar RFA during laparotomy with ultrasound guidance. Early and late, major and minor complications were recorded. Local success was determined on 3-8 month follow-up CT scans of the upper abdomen. RESULTS Nine CRLM, one carcinoid liver metastases and one HCC (3.5-6.6 cm) were ablated with bipolar RFA. Average ablation time was 16 min (range 6-29 min.). Two patients developed a liver abscess which required re-laparotomy. In both cases bowel surgery during the same session probably caused bacterial spill. There were no mortalities. The patients were released from hospital between 5 and 29 days after the procedure (median 12 days). The 6-12 month follow-up PET-CT scans showed signs for marginal RFA-site tumour recurrence in three patients with CRLM (3/11 lesions). CONCLUSION Preliminary results suggest bipolar RFA to be a reasonably safe, fast and feasible technique which seems to improve local control for large size hepatic tumour ablations.
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Zhou P, Liang P, Yu X, Wang Y, Dong B. Percutaneous microwave ablation of liver cancer adjacent to the gastrointestinal tract. J Gastrointest Surg 2009; 13:318-24. [PMID: 18825464 DOI: 10.1007/s11605-008-0710-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Accepted: 09/08/2008] [Indexed: 01/31/2023]
Abstract
PURPOSE The purpose of the study was to prospectively evaluate safety and effectiveness of percutaneous microwave ablation under temperature monitoring assisted with ethanol injection for liver cancer abutting gastrointestinal tract. MATERIALS AND METHODS One hundred seventy-nine hepatic tumors that underwent percutaneous microwave ablation with curative intention were included. Fifty-three lesions located less than 5 mm from gastrointestinal tract were in gastrointestinal group. One hundred twenty-six lesions located more than 5 mm from hepatic surface 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 degrees C and 58 degrees C for more than 10 min for tumors in the gastrointestinal group. Ethanol (2-27 ml) was injected into marginal tissue in 33 of 53 lesions of the GI group. RESULTS Forty-seven of 53 tumors (88.7%) in the gastrointestinal group and 116 of 126 tumors (92.1%) in the control group achieved complete ablation (p > 0.05). There were neither immediate nor periprocedural complications in both groups. Tumor seeding happened in one of the gastrointestinal group and two of the control group. There was no delayed complication of bile ducts injury. CONCLUSION Under strict temperature monitoring, microwave ablation assisted with ethanol injection is safe and achieves a high complete ablation rate for hepatic tumors adjacent to gastrointestinal tract.
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Affiliation(s)
- Pei Zhou
- Department of Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China
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Combined percutaneous radiofrequency ablation and ethanol injection for hepatocellular carcinoma in high-risk locations. AJR Am J Roentgenol 2008; 190:W187-95. [PMID: 18287411 DOI: 10.2214/ajr.07.2537] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate whether combining percutaneous ethanol injection (PEI) with radiofrequency ablation in the management of hepatocellular carcinoma (HCC) in high-risk locations improves treatment outcomes. SUBJECTS AND METHODS We compared the outcome of management of high-risk tumors with PEI and radiofrequency ablation (n = 50) or radiofrequency ablation alone (n = 114) with the outcome of radiofrequency ablation of non-high-risk tumors (n = 44). We also compared the survival rates of patients with and those without high-risk HCC. PEI was performed into the part of the tumor closest to a blood vessel or vital structure before radiofrequency ablation. RESULTS The study included 142 patients with 208 HCCs managed with radiofrequency ablation. Despite larger tumor sizes (2.8 +/- 1 cm vs 1.9 +/- 0.7 cm vs 2.5 +/- 0.1 cm for the high-risk radiofrequency plus PEI, non-high-risk radiofrequency, and high-risk radiofrequency groups, respectively; p < 0.001), the primary effectiveness rate of high-risk radiofrequency ablation and PEI (92%) was similar to that of non-high-risk radiofrequency ablation (96%). The primary effectiveness rate of high-risk radiofrequency ablation and PEI was slightly higher (p = 0.1) than that of high-risk radiofrequency ablation (85%). The local tumor progression rates (21% vs 33% vs 24% at 18 months) of the three respective groups were not statistically different (p = 0.91). Patients with and those without high-risk tumors had equal survival rates (p = 0.42) after 12 (87% vs 100%) and 24 (77% vs 80%) months of follow-up. Independent predictors of primary effectiveness were a tumor size of 3 cm or less (p = 0.01) and distinct tumor borders (p = 0.009). Indistinct borders (p = 0.033) and non-treatment-naive status of HCC (p = 0.002) were associated with higher local tumor progression rates. The only predictor of survival was complete ablation of all index tumors (p = 0.001). CONCLUSION The combination of radiofrequency ablation and PEI in the management of HCC in high-risk locations has a slightly higher primary effectiveness rate than does radiofrequency ablation alone. A randomized controlled study is warranted.
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Catalano O, Vallone P, Izzo F, Siani A. An inaccurate literature review and citation. Radiology 2008; 246:982. [PMID: 18309023 DOI: 10.1148/radiol.2463071311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Polascik TJ, Mouraviev V. The Rise of Ablative Technologies for Treating the Small Renal Mass. Eur Urol 2007; 52:636-8. [PMID: 17383084 DOI: 10.1016/j.eururo.2007.03.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Accepted: 03/01/2007] [Indexed: 11/26/2022]
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