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Vietti Violi N, Duran R, Guiu B, Cercueil JP, Aubé C, Digklia A, Pache I, Deltenre P, Knebel JF, Denys A. Efficacy of microwave ablation versus radiofrequency ablation for the treatment of hepatocellular carcinoma in patients with chronic liver disease: a randomised controlled phase 2 trial. Lancet Gastroenterol Hepatol 2018; 3:317-325. [DOI: 10.1016/s2468-1253(18)30029-3] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/16/2018] [Accepted: 01/17/2018] [Indexed: 02/07/2023]
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Loriaud A, Denys A, Seror O, Vietti Violi N, Digklia A, Duran R, Trillaud H, Hocquelet A. Hepatocellular carcinoma abutting large vessels: comparison of four percutaneous ablation systems. Int J Hyperthermia 2018; 34:1171-1178. [PMID: 29457510 DOI: 10.1080/02656736.2018.1440017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To compare overall local tumour progression (OLTP), defined as the failure of primary ablation or local tumour progression, with single applicator monopolar radiofrequency ablation (RFA), microwave ablation (MWA), cluster-RFA and multi-bipolar radiofrequency (mbpRFA) in the treatment of hepatocellular carcinoma (HCC) ≤ 5 cm abutting large vessels (≥3 mm). MATERIALS AND METHODS This multicenter, retrospective, per-nodule study was performed from 2007 to 2015. The study was approved by the ethics review board, and informed consent was waived. A total of 160/914 HCC nodules treated by thermal ablation and abutting large vessels (40 per treatment group) treated by monopolar RFA, MWA, cluster-RFA or mbpRFA were matched for tumour size, alpha-feto-protein level and vessel size. OLTP rates were compared by the log-rank test and the multivariate Cox model after matching. RESULTS No differences were observed in tumour size, vessel size or alpha-feto-protein levels among the three groups (p = 1). The cumulative 4-year OLTP rates following monopolar RFA, cluster-RFA, multi-bipolar RFA and MWA were 50.5%, 16.3%, 16.3% and 44.2%, respectively (p = 0.036). On multivariate Cox regression, vessel size ≥10 mm, monopolar RFA and MWA were independent risk factors of OLTP compared to cluster-RFA or mbpRFA. CONCLUSION Multi-applicator RFA provides better local tumour control in HCC abutting large vessels than single-applicator techniques (monopolar RFA or MWA).
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Affiliation(s)
- Amélie Loriaud
- a Department of Diagnostic and Interventional Radiology , Hopital Saint-André, Centre Hospitalier Universitaire de Bordeaux , Bordeaux , France
| | - Alban Denys
- b Department of Radiodiagnostic and Interventional Radiology , Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne , Lausanne , Switzerland
| | - Olivier Seror
- c Department of Radiology , Hôpital Jean Verdier (Assistance Publique-Hôpitaux de Paris) , Bondy , France
| | - Naik Vietti Violi
- b Department of Radiodiagnostic and Interventional Radiology , Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne , Lausanne , Switzerland
| | - Antonia Digklia
- b Department of Radiodiagnostic and Interventional Radiology , Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne , Lausanne , Switzerland
| | - Rafael Duran
- b Department of Radiodiagnostic and Interventional Radiology , Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne , Lausanne , Switzerland
| | - Hervé Trillaud
- a Department of Diagnostic and Interventional Radiology , Hopital Saint-André, Centre Hospitalier Universitaire de Bordeaux , Bordeaux , France.,d EA IMOTION (Imagerie moléculaire et thérapies innovantes en oncologie) , Université de Bordeaux , Bordeaux , France
| | - Arnaud Hocquelet
- b Department of Radiodiagnostic and Interventional Radiology , Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne , Lausanne , Switzerland.,d EA IMOTION (Imagerie moléculaire et thérapies innovantes en oncologie) , Université de Bordeaux , Bordeaux , France
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Morisco F, Camera S, Guarino M, Tortora R, Cossiga V, Vitiello A, Cordone G, Caporaso N, Di Costanzo GG. Laser ablation is superior to TACE in large-sized hepatocellular carcinoma: a pilot case-control study. Oncotarget 2018; 9:17483-17490. [PMID: 29707122 PMCID: PMC5915130 DOI: 10.18632/oncotarget.24756] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 02/27/2018] [Indexed: 12/25/2022] Open
Abstract
Background Limited therapies are available for large (≥40 mm) unresectable hepatocellular carcinoma (HCC). Currently, the standard treatment with transarterial chemoembolisation (TACE) is unsatisfactory with high recurrence rate and limited effect on survival. Laser Ablation (LA) has emerged as a relatively new technique characterized by high efficacy and good safety. This study is aimed to evaluate the efficacy of LA in comparison to TACE in patients with large HCC. Methods Eighty-two patients with a single HCC nodule ≥40 mm (BCLC stage A or B) were enrolled in this case-control study. Forty-one patients were treated with LA and 41 patients were treated with TACE. Response to therapy was evaluated according to the mRECIST criteria. Survival was calculated with Kaplan-Meier from the time of cancer diagnosis to death with values censored at the date of the last follow-up. Results Twenty-six (63.4%) and 8 (19.5%) patients had a complete response after LA and TACE, respectively (p < 0.001). Subsequently we stratified the HCCs in 3 categories according to the nodule size: 40–50 mm, 51–60 mm, and >60 mm. LA resulted superior to TACE especially in nodules ranging between 51 and 60 mm in diameter, with a complete response rate post-LA and post-TACE of 75% and 14.3%, respectively (p = 0.0133). The 36 months cumulative survival rate in patients treated with LA and TACE was 55.4% and 48.8%, respectively. The disease recurrence rates after LA and TACE were 19.5% and 75.0%, respectively. Conclusions LA is a more effective therapeutic option than TACE in patients with solitary large HCC.
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Affiliation(s)
- Filomena Morisco
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Silvia Camera
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Maria Guarino
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | | | - Valentina Cossiga
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Anna Vitiello
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | | | - Nicola Caporaso
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
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Wang L, Chen C, Feng S, Tian J. TIPE‑2 suppresses growth and aggressiveness of hepatocellular carcinoma cells through downregulation of the phosphoinositide 3‑kinase/AKT signaling pathway. Mol Med Rep 2018; 17:7017-7026. [PMID: 29568863 PMCID: PMC5928656 DOI: 10.3892/mmr.2018.8789] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 12/14/2017] [Indexed: 12/13/2022] Open
Abstract
Rapid proliferation and migration are the main features of hepatocellular carcinoma (HCC) cells, which serve an essential role in carcinogenesis and are a hallmark of cancer therapy resistance. Previous studies have reported that tumor necrosis factor-α-induced protein-8 like-2 (TIPE-2) is involved in cancer initiation and the progression of HCC. The present study aimed to clarify the role of TIPE-2 in HCC carcinogenesis, growth and aggressiveness. The effects of TIPE-2 on HCC were determined using colony forming and cell cycle analyses. Cell apoptosis, and growth and aggressiveness of HCC cells, were investigated following TIPE-2 treatment. Treatment with TIPE-2 markedly suppressed HCC cell proliferation and increased the number of cells in S phase of the cell cycle. The results demonstrated that TIPE-2 significantly inhibited growth, migration and invasion of HCC cells via the downregulation of tumor metastasis-associated genes. Flow cytometric analysis indicated that TIPE-2 promoted apoptosis of HCC cells via regulation of apoptosis-associated gene transcription. In addition, TIPE-2 administration downregulated the expression of phosphoinositide 3-kinase (PI3K) and protein kinase B (AKT) in HCC cells. In addition, TIPE-2 selectively decreased neuroblastoma Ras viral oncogene and p27 expression in HCC cells. In vivo assays revealed that TIPE-2 significantly inhibited tumor growth and prolonged animal survival by promoting apoptosis of tumor cells. The results of the present study indicated that TIPE-2 acts as an inhibitor of HCC cell growth and aggressiveness, and promotes apoptosis, thus suggesting that TIPE-2 may inhibit the metastasis-associated PI3K/AKT signaling cascade and may arrest the tumor cell cycle. These findings provide a potential molecular mechanism by which TIPE-2 promotes apoptosis of HCC cells.
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Affiliation(s)
- Lin Wang
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin Geriatrics Institute, Tianjin 300052, P.R. China
| | - Chen Chen
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin Geriatrics Institute, Tianjin 300052, P.R. China
| | - Shuzhi Feng
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin Geriatrics Institute, Tianjin 300052, P.R. China
| | - Jianli Tian
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin Geriatrics Institute, Tianjin 300052, P.R. China
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Cassinotto C, Denys A, Gay F, Duran R, Hocquelet A, Piron L, Guiu B. Radiofrequency Ablation of Liver Tumors: No Difference in the Ablation Zone Volume Between Cirrhotic and Healthy Liver. Cardiovasc Intervent Radiol 2018; 41:905-911. [DOI: 10.1007/s00270-018-1898-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 02/07/2018] [Indexed: 01/20/2023]
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Boyer A, Jegonday MA, Lanot A, Ficheux M, Lobbedez T, Bechade C. Percutaneous Ablation for Hepatocellular Carcinoma and Peritoneal Dialysis. Perit Dial Int 2017; 37:656-658. [DOI: 10.3747/pdi.2017.00073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the second leading cause of death by cancer worldwide. Resection and liver transplantation are the gold standards, but only a minority of people are eligible. Percutaneous ablation therapies, such as microwave ablation (MWA), have consequently been developed. There is a lack of guidelines regarding the treatment of HCCs in end-stage renal disease (ESRD) patients. Here, we report the case of a 67-year-old patient who was undergoing peritoneal dialysis (PD) for chronic congestive heart failure and who presented with an HCC while undergoing PD. The tumor size was 48 mm. Due to the patient's comorbidities, MWA was chosen as a first-line treatment. Peritoneal dialysis was stopped 1 day before the MWA, which was performed by an interventional radiology department. There were no complications from the procedure. The treated area completely covered the tumoral lesion. Peritoneal dialysis was resumed 3 weeks after the MWA without any complications. The computed tomography (CT) scan performed 3 months later showed that the tumor mass had completely regressed; a year and a half after the MWA, no recurrence has been observed. This report shows that an MWA of an HCC in PD patients is a feasible and safe procedure.
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Affiliation(s)
| | | | | | | | - Thierry Lobbedez
- Service de Néphrologie, CHU de Caen, Caen, France
- Normandie, France Université de Caen Normandie, Medical school, Caen, France
- RDPLF Pontoise, France
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Abstract
OPINION STATEMENT Percutaneous thermal ablation, including microwave ablation (MWA), radiofrequency ablation (RFA), and cryoablation, is a well-established focal treatment option for primary and metastatic malignancies. While published literature specific to ablation of sarcomas is relatively lacking compared with non-sarcomatous malignancies, what is available is promising. In situations where a focal treatment option is desired, strong consideration should be given to percutaneous thermal ablation, in addition to surgery and radiation therapy. A significant advantage of percutaneous thermal ablation over surgery and radiation includes the repeatability of ablation, as there is no absolute limit on the number of times an ablation can be performed. Compared with surgery, ablation offers the potential of decreased recovery time, a less invasive procedure, and is often performed in patients deemed not medically fit for surgery.
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58
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Crocetti L, Bargellini I, Cioni R. Loco-regional treatment of HCC: current status. Clin Radiol 2017; 72:626-635. [PMID: 28258743 DOI: 10.1016/j.crad.2017.01.013] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 01/18/2017] [Accepted: 01/25/2017] [Indexed: 02/06/2023]
Abstract
Hepatocellular carcinoma (HCC) represents one of the few cancers for which locoregional treatments are recognised as being able to cure and/or prolong survival and are included in international guidelines. This is due to the unique nature of HCC, in most cases occurring in patients with underlying virus- or alcohol-related cirrhosis. The treatment choice in patients with HCC is therefore driven not only by tumour staging, as in the great majority of cancers, but also by careful evaluation of liver function and physical status. Another specific feature of HCC is that it is the only tumour that can be cured by organ transplantation, with the aim of treating both the cancer and underlying liver disease. These characteristics configure a complex scenario and prompt the need for close cooperation among interventional oncologists, surgeons, hepatologists, and anaesthesiologists. In patients with limited hepatic disease, preserved hepatic function and good performance status, categorised as very early and early-stage HCC according to the Barcelona Clinic Liver Cancer (BCLC) classification, image-guided tumour ablation is included among the curative treatments. More than half of patients with HCC are, however, diagnosed late, despite the widespread implementation of surveillance programmes, when curative treatments cannot be applied. For patients presenting with multinodular HCC and relatively preserved liver function, absence of cancer-related symptoms, and no evidence of vascular invasion or extrahepatic spread transcatheter arterial chemoembolisation (TACE) is the current standard of care. Although anti-tumour activity and promising survival results has been reported in cohorts of patients with advanced HCC treated with radio-embolisation, systemic treatment with the multi-kinase inhibitor, sorafenib, is still recommended for patients at this stage. In this article, current treatment strategies for HCC according to tumour stage are discussed, underlining the latest advances in the literature and technical developments.
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Affiliation(s)
- L Crocetti
- Division of Interventional Radiology, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Cisanello University Hospital, Pisa, Italy.
| | - I Bargellini
- Division of Interventional Radiology, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Cisanello University Hospital, Pisa, Italy
| | - R Cioni
- Division of Interventional Radiology, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Cisanello University Hospital, Pisa, Italy
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59
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Luo W, Zhang Y, He G, Yu M, Zheng M, Liu L, Zhou X. Effects of radiofrequency ablation versus other ablating techniques on hepatocellular carcinomas: a systematic review and meta-analysis. World J Surg Oncol 2017; 15:126. [PMID: 28693505 PMCID: PMC5504820 DOI: 10.1186/s12957-017-1196-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/22/2017] [Indexed: 12/12/2022] Open
Abstract
Background Percutaneous ablation has quickly arisen as one of the important alternative treatments for hepatocellular carcinoma (HCC). We aimed to compare the therapeutic effects of radiofrequency ablation (RFA) and other ablative techniques on HCCs. Methods Databases were searched to identify literature on complete tumor ablation (CTA), overall survival (OS), local tumor recurrence (LTR), and complications of RFA in the treatment of HCC, compared with those of microwave ablation (MWA), percutaneous ethanol injection (PEI), PEI plus RFA, cryoablation (CRA), laser ablation (LSA), and high-intensity focused ultrasound. Randomized controlled trials and high-quality cohort studies were included in the assessment. Results The effects of MWA and CRA appeared to be similar to those of RFA, but lower rates of LTR and higher rates of CTA in large tumors compared with RFA were reported (P < 0.05). CTA rates were lower in patients treated with PEI (odds ratio [OR] 0.16, 95% confidence interval [CI] 0.06–0.42), and higher in those treated with PEI plus RFA (OR 2.28, 95% CI 1.19–3.60), with an increased incidence of fever (P < 0.05). LSA resulted in lower CTA rates (OR 0.32, 95% CI 0.13–0.81) and OS (hazard ratio 1.47, 95% CI 1.01–2.15), with a lower incidence of complications. Conclusions Compared with RFA, identical effects were found in MWA and CRA groups. Fewer complications were observed in PEI and LSA group. PEI plus RFA appeared more effective, with a higher rate of complications. Well-designed randomized controlled trials are further needed to confirm above results.
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Affiliation(s)
- Wen Luo
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, No. 127 Changle Xi Road, Xi'an, China
| | - Yunfei Zhang
- Research Institution of Bone tumor, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Guangbin He
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, No. 127 Changle Xi Road, Xi'an, China
| | - Ming Yu
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, No. 127 Changle Xi Road, Xi'an, China
| | - Minjuan Zheng
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, No. 127 Changle Xi Road, Xi'an, China
| | - Liwen Liu
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, No. 127 Changle Xi Road, Xi'an, China.
| | - Xiaodong Zhou
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, No. 127 Changle Xi Road, Xi'an, China.
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60
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Salati U, Barry A, Chou FY, Ma R, Liu DM. State of the ablation nation: a review of ablative therapies for cure in the treatment of hepatocellular carcinoma. Future Oncol 2017; 13:1437-1448. [DOI: 10.2217/fon-2017-0061] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Primary liver cancer, mainly hepatocellular carcinoma, is one of the most common malignancies worldwide. Surgical management, either resection or transplantation, is considered definitive treatment, however, less than 20% of patients are ultimately candidates. Thermal ablation modalities such as radiofrequency ablation and microwave ablation have evolved such that these modalities have been applied with curative intent. Moreover, thermal ablation has demonstrated efficacy in treating early-stage tumors and can be offered as first-line treatment in patients with uncomplicated disease. Attributing to refinements in technology and techniques, recent studies evaluating stereotactic ablative body radiotherapy have shown promising results, while irreversible electroporation, an emerging modality, may further expand the role of ablative therapy in treating potentially resectable hepatocellular carcinoma.
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Affiliation(s)
- Umer Salati
- Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Aisling Barry
- Department of Radiation Oncology, BC Cancer Agency, Vancouver, BC, Canada
| | - Frank Y Chou
- Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Roy Ma
- Department of Radiation Oncology, BC Cancer Agency, Vancouver, BC, Canada
| | - David M Liu
- Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
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61
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Li W, Zhou X, Huang Z, Zhang K, Luo X, Zhong J, Chen Y. Short-term and long-term outcomes of laparoscopic hepatectomy, microwave ablation, and open hepatectomy for small hepatocellular carcinoma: a 5-year experience in a single center. Hepatol Res 2017; 47:650-657. [PMID: 27487979 DOI: 10.1111/hepr.12785] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 06/28/2016] [Accepted: 07/26/2016] [Indexed: 12/12/2022]
Abstract
AIM Laparoscopic hepatectomy (LH), microwave ablation (MWA), and open hepatectomy (OH) are three widely used methods to treat small hepatocellular carcinoma (HCC). However, few studies have compared the short- and long-term outcomes of these three treatments. The aim of this study was to investigate their effectiveness. METHODS The data were reviewed from 280 patients with HCCs measuring ≤3 cm (Barcelona Clinic Liver Cancer stage 0 or A) who received LH (n = 133), OH (n = 87), or MWA (n = 60) in our research center from 2005 to 2010. Short-term outcomes included intraoperative blood loss, operation time, and length of hospital stay. The disease-free survival and overall survival rates were analyzed as long-term outcomes. RESULTS The patients in the MWA and LH groups showed better short-term outcomes compared with those in the OH group. There were no significant differences in overall survival rates among the three treatments. The LH group showed significantly lower recurrence rates than the MWA group (P = 0.0146). CONCLUSIONS Laparoscopic hepatectomy may be a better option for patients with small HCC located on the liver surface and left lateral lobe. The short-term outcome of MWA is promising, although the high risk of local recurrence after the operation should be considered when planning treatment.
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Affiliation(s)
- Wenda Li
- Department of Hepatobiliary Surgery, The Sun Yat-sen memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xue Zhou
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zejian Huang
- Department of Hepatobiliary Surgery, The Sun Yat-sen memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kelin Zhang
- Department of Surgical Intensive Care Unit, The Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xuan Luo
- Department of Hepatobiliary Surgery, The Sun Yat-sen memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jinyi Zhong
- Department of Hepatobiliary Surgery, The Sun Yat-sen memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yajin Chen
- Department of Hepatobiliary Surgery, The Sun Yat-sen memorial Hospital of Sun Yat-sen University, Guangzhou, China
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62
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Lee MW, Raman SS, Asvadi NH, Siripongsakun S, Hicks RM, Chen J, Worakitsitisatorn A, McWilliams J, Tong MJ, Finn RS, Agopian VG, Busuttil RW, Lu DSK. Radiofrequency ablation of hepatocellular carcinoma as bridge therapy to liver transplantation: A 10-year intention-to-treat analysis. Hepatology 2017; 65:1979-1990. [PMID: 28170115 DOI: 10.1002/hep.29098] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 01/26/2017] [Accepted: 01/30/2017] [Indexed: 12/14/2022]
Abstract
UNLABELLED In a long-term (10-year) study of radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) as bridging therapy in patients listed for orthotopic liver transplantation (LT), we evaluated the impact of RFA on waiting list dropout rate, post-LT tumor recurrence, and long-term intention-to-treat, disease-specific survival (DSS). From March 2004 to October 2014, RFA was performed as the initial stand-alone bridge therapy to LT for 121 patients (men/women ratio, 83:38; mean age, 60.0 years) with 156 de novo HCCs (mean size, 2.4 cm). Follow-up period from initial RFA ranged from 1.3 to 128.0 months (median, 42.9 months). We assessed the overall and tumor-specific waiting list dropout rates, post-LT tumor recurrence, and 10-year post-LT and intention-to-treat survival rates. Dropout from the waiting list due to tumor progression occurred in 7.4% of patients. HCC recurrence after LT occurred in 5.6% of patients. The post-LT overall survival (OS) rate at 5 and 10 years was 75.8% and 42.2%, respectively, and the recurrence-free survival (RFS) rate was 71.1% and 39.6%, respectively. Intention-to-treat OS, RFS, and DSS rates for the entire study population at 5 and 10 years were 63.5% and 41.2%, 60.8% and 37.7%, and 89.5% and 89.5%, respectively. CONCLUSION RFA as a first-line stand-alone bridge therapy to LT achieves excellent long-term overall and tumor-specific survivals, with a low dropout rate from tumor progression despite long wait list times and a sustained low tumor recurrence rate upon post-LT follow-up of up to 10 years. (Hepatology 2017;65:1979-1990).
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Affiliation(s)
- Min Woo Lee
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA.,Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Steven S Raman
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA
| | - Nazanin H Asvadi
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA
| | - Surachate Siripongsakun
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA.,Department of Radiology, Chulabhorn Hospital, Bangkok, Thailand
| | - Robert M Hicks
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA
| | - Jeffrey Chen
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA
| | - Akeanong Worakitsitisatorn
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA.,Department of Radiology, Chulabhorn Hospital, Bangkok, Thailand
| | - Justin McWilliams
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA
| | - Myron J Tong
- Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Richard S Finn
- Department of Medicine, Division of Hematology/Oncology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Vatche G Agopian
- Department of Surgery, Dumont-UCLA Transplant and Liver Cancer Centers, Los Angeles, CA
| | - Ronald W Busuttil
- Department of Surgery, Dumont-UCLA Transplant and Liver Cancer Centers, Los Angeles, CA
| | - David S K Lu
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA
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63
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The current role of radiofrequency ablation in the treatment of hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int 2017; 16:122-126. [PMID: 28381374 DOI: 10.1016/s1499-3872(16)60182-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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64
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Peng C, Zhang Z, Liu J, Chen H, Tu X, Hu R, Ni J, Weng N, Pang H, Xue Z. Efficacy and safety of ultrasound-guided radiofrequency ablation of hyperplastic parathyroid gland for secondary hyperparathyroidism associated with chronic kidney disease. Head Neck 2016; 39:564-571. [PMID: 28032671 DOI: 10.1002/hed.24657] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 10/10/2016] [Accepted: 10/27/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine if ultrasound-guided radiofrequency ablation (RFA) of hyperplastic parathyroid glands could be used to treat secondary hyperparathyroidism (HPT) in patients with chronic kidney disease. METHODS RFA of the hyperplastic parathyroid glands was performed in 34 patients with secondary HPT. Intact parathyroid hormone (iPTH), calcium, and phosphorus were measured. The outcome was based on the ablation extent (ie, 4, 3, and 1-2 glands). RESULTS The iPTH, calcium, and phosphorus levels decreased in all groups after RFA. One year after ablation, these parameters remained significantly lower in the 4-gland ablation group compared with the 3-gland and 1 to 2-gland groups. The same tendency was observed for the symptom score. The iPTH levels of <272 pg/mL on the day after ablation was the best predictor for maintaining parathyroid hormone (PTH) levels in a reasonable range 1 year after ablation. CONCLUSIONS RFA of hyperplastic parathyroid glands for treating secondary HPT is feasible in selected patients. © 2016 Wiley Periodicals, Inc. Head Neck 39: 564-571, 2017.
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Affiliation(s)
- Chengzhong Peng
- Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang Province, China
| | - Zhengxian Zhang
- Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang Province, China
| | - Jibin Liu
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Hongyu Chen
- Department of Nephrology, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang Province, China
| | - Xiao Tu
- Department of Nephrology, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang Province, China
| | - Rihong Hu
- Department of Nephrology, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang Province, China
| | - Jun Ni
- Department of Nephrology, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang Province, China
| | - Ning Weng
- Department of Nephrology, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang Province, China
| | - Haisu Pang
- Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang Province, China
| | - Zhengmei Xue
- Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang Province, China
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Facciorusso A, Serviddio G, Muscatiello N. Local ablative treatments for hepatocellular carcinoma: An updated review. World J Gastrointest Pharmacol Ther 2016; 7:477-489. [PMID: 27867681 PMCID: PMC5095567 DOI: 10.4292/wjgpt.v7.i4.477] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 07/06/2016] [Accepted: 08/18/2016] [Indexed: 02/06/2023] Open
Abstract
Ablative treatments currently represent the first-line option for the treatment of early stage unresectable hepatocellular carcinoma (HCC). Furthermore, they are effective as bridging/downstaging therapies before orthotopic liver transplantation. Contraindications based on size, number, and location of nodules are quite variable in literature and strictly dependent on local expertise. Among ablative therapies, radiofrequency ablation (RFA) has gained a pivotal role due to its efficacy, with a reported 5-year survival rate of 40%-70%, and safety. Although survival outcomes are similar to percutaneous ethanol injection, the lower local recurrence rate stands for a wider application of RFA in hepato-oncology. Moreover, RFA seems to be even more cost-effective than liver resection for very early HCC (single nodule ≤ 2 cm) and in the presence of two or three nodules ≤ 3 cm. There is increasing evidence that combining RFA to transarterial chemoembolization may increase the therapeutic benefit in larger HCCs without increasing the major complication rate, but more robust prospective data is still needed to validate these pivotal findings. Among other thermal treatments, microwave ablation (MWA) uses high frequency electromagnetic energy to induce tissue death via coagulation necrosis. In comparison to RFA, MWA has several theoretical advantages such as a broader zone of active heating, higher temperatures within the targeted area in a shorter treatment time and the lack of heat-sink effect. The safety concerns raised on the risks of this procedure, due to the broader and less predictable necrosis areas, have been recently overcome. However, whether MWA ability to generate a larger ablation zone will translate into a survival gain remains unknown. Other treatments, such as high-intensity focused ultrasound ablation, laser ablation, and cryoablation, are less investigated but showed promising results in early HCC patients and could be a valuable therapeutic option in the next future.
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Microwave ablation of hepatocellular carcinoma as first-line treatment: long term outcomes and prognostic factors in 221 patients. Sci Rep 2016; 6:32728. [PMID: 27620527 PMCID: PMC5020644 DOI: 10.1038/srep32728] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 08/11/2016] [Indexed: 12/19/2022] Open
Abstract
This retrospective study aimed at evaluating the long-term outcomes and prognostic factors of microwave ablation (MWA) as a first-line treatment for hepatocellular carcinoma (HCC). 221 consecutive patients receiving MWA in our center between October 11, 2010 and December 31, 2013 were enrolled. Technique effectiveness was evaluated one month post-ablation. Initial complete ablation (CA1st) was gained in 201 (90.95%) patients, secondary CA (CA2nd) in 8 (3.62%) patients and the remaining 12 (5.43%) patients suffered from incomplete ablation (IA2nd) after two sessions of MWA. Patients with tumor size >5 cm were less likely to gain CA1st. Procedure-related complications were recorded and no procedure-related death occurred. 22 (10.4%) complications occurred with 8 (3.8%) being major ones. Tumor characteristics (size, number, location) do not significantly influence complication rates. After a median follow-up of 41.0 (ranging 25.0–63.5) months, the median RFS and OS was 14.0 months (95% CI: 9.254–18.746) and 41.0 months (95% CI: 33.741–48.259) respectively. Multivariate analysis identified two significant prognosticators (levels of alpha fetal protein [AFP] and gamma-glutamyl transpeptidase [GGT]) of RFS and five significant prognosticators (tumor number, tumor size, AFP, GGT and recurrence type) of OS. In conclusion, MWA provides high technique effectiveness rate and is well tolerated in patients with HCC as a first-line treatment.
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Santambrogio R, Chiang J, Barabino M, Meloni FM, Bertolini E, Melchiorre F, Opocher E. Comparison of Laparoscopic Microwave to Radiofrequency Ablation of Small Hepatocellular Carcinoma (≤3 cm). Ann Surg Oncol 2016; 24:257-263. [PMID: 27581608 DOI: 10.1245/s10434-016-5527-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Laparoscopic thermal ablation is a common alternative to surgical resection in treating hepatic tumors, particularly in those located in difficult-to-reach locations. OBJECTIVE The aim of this study was to compare the safety and long-term efficacy of laparoscopic radiofrequency ablation (RFA) and microwave ablation (MWA) in treating hepatocellular carcinoma (HCC). METHOD From February 2009 to May 2015, data from patients with HCC nodules who had undergone either laparoscopic MWA or laparoscopic RFA were examined. Complications, complete ablation rates, local tumor progression (LTP) rates, and disease-free and cumulative survival rates were compared between the two treatment groups. RESULTS A total of 154 patients with HCC (60 MWA and 94 RFA) were treated via the laparoscopic approach. Major complication rates were identified as 1 and 2 % in the RFA and MWA groups, respectively (p = 0.747). Complete ablation rates were 95 % for both treatment groups (p = 0.931), and LTP rates were 21.2 % for RFA and 8.3 % for MWA (p = 0.034). Disease-free survival rates at 5 years were 19 % in the RFA group and 12 % in the MWA group (p = 0.434), while cumulative survival rates at 5 years were 50 % in the RFA group and 37 % in the MWA group (p = 0.185). CONCLUSION Laparoscopic RFA and MWA appear to be safe in the treatment of early-stage HCC. The LTP rates were lower in the laparoscopic MWA group compared with the laparoscopic RFA group, but their respective overall and disease-free survival rates remained similar.
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Affiliation(s)
- Roberto Santambrogio
- UOC di Chirurgia Epato-bilio-pancreatica e Digestiva, Ospedale San Paolo, Università di Milano, Milan, Italy.
| | - Jason Chiang
- Department of Radiology, University of Wisconsin, Madison, WI, USA
| | - Matteo Barabino
- UOC di Chirurgia Epato-bilio-pancreatica e Digestiva, Ospedale San Paolo, Università di Milano, Milan, Italy
| | - Franca Maria Meloni
- Servizio di Radiologia Ecografia Interventistica, Ospedale Valduce, Como, Italy.,Servizio di radiologia Interventistica e di Procedure Speciali, Casa di Cura Igea, Milan, Italy
| | - Emanuela Bertolini
- Divisione di Medicina Interna-Epatologia, San Paolo Hospital, University of Milan School of Medicine, Milan, Italy
| | - Fabio Melchiorre
- Servizio di Radiologia Diagnostica ed Interventistica, Ospedale San Paolo, Università di Milano, Milan, Italy
| | - Enrico Opocher
- UOC di Chirurgia Epato-bilio-pancreatica e Digestiva, Ospedale San Paolo, Università di Milano, Milan, Italy
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Hoffmann R, Rempp H, Keßler DE, Weiß J, Pereira PL, Nikolaou K, Clasen S. MR-guided microwave ablation in hepatic tumours: initial results in clinical routine. Eur Radiol 2016; 27:1467-1476. [PMID: 27553935 DOI: 10.1007/s00330-016-4517-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 05/11/2016] [Accepted: 07/19/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Evaluation of the technical success, patient safety and technical effectiveness of magnetic resonance (MR)-guided microwave ablation of hepatic malignancies. METHODS Institutional review board approval and informed patient consent were obtained. Fifteen patients (59.8 years ± 9.5) with 18 hepatic malignancies (7 hepatocellular carcinomas, 11 metastases) underwent MR-guided microwave ablation using a 1.5-T MR system. Mean tumour size was 15.4 mm ± 7.7 (7-37 mm). Technical success and ablation zone diameters were assessed by post-ablative MR imaging. Technique effectiveness was assessed after 1 month. Complications were classified according to the Common Terminology Criteria for Adverse Events (CTCAE). Mean follow-up was 5.8 months ± 2.6 (1-10 months). RESULTS Technical success and technique effectiveness were achieved in all lesions. Lesions were treated using 2.5 ± 1.2 applicator positions. Mean energy and ablation duration per tumour were 37.6 kJ ± 21.7 (9-87 kJ) and 24.7 min ± 11.1 (7-49 min), respectively. Coagulation zone short- and long-axis diameters were 31.5 mm ± 10.5 (16-65 mm) and 52.7 mm ± 15.4 (27-94 mm), respectively. Two CTCAE-2-complications occurred (pneumothorax, pleural effusion). Seven patients developed new tumour manifestations in the untreated liver. Local tumour progression was not observed. CONCLUSIONS Microwave ablation is feasible under near real-time MR guidance and provides effective treatment of hepatic malignancies in one session. KEY POINTS • Planning, applicator placement and therapy monitoring are possible without using contrast enhancement • Energy transmission from the generator to the scanner room is safely possible • MR-guided microwave ablation provides effective treatment of hepatic malignancies in one session • Therapy monitoring is possible without applicator retraction from the ablation site.
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Affiliation(s)
- Rüdiger Hoffmann
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany.
| | - Hansjörg Rempp
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - David-Emanuel Keßler
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Jakob Weiß
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Philippe L Pereira
- Department of Radiology, Minimally Invasive Therapies and Nuclear Medicine, SLK-Kliniken Heilbronn GmbH, Am Gesundbrunnen 20-26, 74078, Heilbronn, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Stephan Clasen
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
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Velez E, Goldberg SN, Kumar G, Wang Y, Gourevitch S, Sosna J, Moon T, Brace CL, Ahmed M. Hepatic Thermal Ablation: Effect of Device and Heating Parameters on Local Tissue Reactions and Distant Tumor Growth. Radiology 2016; 281:782-792. [PMID: 27409564 DOI: 10.1148/radiol.2016152241] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Purpose To determine whether variable hepatic microwave ablation (MWA) can induce local inflammation and distant pro-oncogenic effects compared with hepatic radiofrequency ablation (RFA) in an animal model. Materials and Methods In this institutional Animal Care and Use Committee-approved study, F344 rats (150 gm, n = 96) with subcutaneous R3230 breast adenocarcinoma tumors had normal non-tumor-bearing liver treated with RFA (70°C × 5 minutes), rapid higher-power MWA (20 W × 15 seconds), slower lower-power MWA (5 W × 2 minutes), or a sham procedure (needle placement without energy) and were sacrificed at 6 hours to 7 days (four time points; six animals per arm per time point). Ablation settings produced 11.4 mm ± 0.8 of coagulation for all groups. Distant tumor growth rates were determined to 7 days after treatment. Liver heat shock protein (HSP) 70 levels (at 72 hours) and macrophages (CD68 at 7 days), tumor proliferative indexes (Ki-67 and CD34 at 7 days), and serum and tissue levels of interleukin 6 (IL-6) at 6 hours, hepatocyte growth factor (HGF) at 72 hours, and vascular endothelial growth factor (VEGF) at 72 hours after ablation were assessed. All data were expressed as means ± standard deviations and were compared by using two-tailed t tests and analysis of variance for selected group comparisons. Linear regression analysis of tumor growth curves was used to determine pre- and posttreatment growth curves on a per-tumor basis. Results At 7 days, hepatic ablations with 5-W MWA and RFA increased distant tumor size compared with 20-W MWA and the sham procedure (5-W MWA: 16.3 mm ± 1.1 and RFA: 16.3 mm ± 0.9 vs sham: 13.6 mm ± 1.3, P < .01, and 20-W MWA: 14.6 mm ± 0.9, P < .05). RFA and 5-W MWA increased postablation tumor growth rates compared with the 20-W MWA and sham arms (preablation growth rates range for all arms: 0.60-0.64 mm/d; postablation: RFA: 0.91 mm/d ± 0.11, 5-W MWA: 0.91 mm/d ± 0.14, P < .01 vs pretreatment; 20-W MWA: 0.69 mm/d ± 0.07, sham: 0.56 mm/d ± 1.15; P = .48 and .65, respectively). Tumor proliferation (Ki-67 percentage) was increased for 5-W MWA (82% ± 5) and RFA (79% ± 5), followed by 20-W MWA (65% ± 2), compared with sham (49% ± 5, P < .01). Likewise, distant tumor microvascular density was greater for 5-W MWA and RFA (P < .01 vs 20-W MWA and sham). Lower-energy MWA and RFA also resulted in increased HSP 70 expression and macrophages in the periablational rim (P < .05). Last, IL-6, HGF, and VEGF elevations were seen in 5-W MWA and RFA compared with 20-W MWA and sham (P < .05). Conclusion Although hepatic MWA can incite periablational inflammation and increased distant tumor growth similar to RFA in an animal tumor model, higher-power, faster heating protocols may potentially mitigate such undesired effects. © RSNA, 2016.
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Affiliation(s)
- Erik Velez
- From the Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 1 Deaconess Rd, Boston, MA 02215 (E.V., S.N.G., G.K., Y.W., J.S., M.A.); Division of Image-guided Therapy and Interventional Oncology, Department of Radiology (S.N.G., J.S.), and Goldyne Savad Institute of Gene Therapy (S.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; and Departments of Radiology and Biomedical Engineering, University of Wisconsin-Madison, Madison, Wis (T.M., C.B.)
| | - S Nahum Goldberg
- From the Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 1 Deaconess Rd, Boston, MA 02215 (E.V., S.N.G., G.K., Y.W., J.S., M.A.); Division of Image-guided Therapy and Interventional Oncology, Department of Radiology (S.N.G., J.S.), and Goldyne Savad Institute of Gene Therapy (S.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; and Departments of Radiology and Biomedical Engineering, University of Wisconsin-Madison, Madison, Wis (T.M., C.B.)
| | - Gaurav Kumar
- From the Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 1 Deaconess Rd, Boston, MA 02215 (E.V., S.N.G., G.K., Y.W., J.S., M.A.); Division of Image-guided Therapy and Interventional Oncology, Department of Radiology (S.N.G., J.S.), and Goldyne Savad Institute of Gene Therapy (S.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; and Departments of Radiology and Biomedical Engineering, University of Wisconsin-Madison, Madison, Wis (T.M., C.B.)
| | - Yuanguo Wang
- From the Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 1 Deaconess Rd, Boston, MA 02215 (E.V., S.N.G., G.K., Y.W., J.S., M.A.); Division of Image-guided Therapy and Interventional Oncology, Department of Radiology (S.N.G., J.S.), and Goldyne Savad Institute of Gene Therapy (S.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; and Departments of Radiology and Biomedical Engineering, University of Wisconsin-Madison, Madison, Wis (T.M., C.B.)
| | - Svetlana Gourevitch
- From the Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 1 Deaconess Rd, Boston, MA 02215 (E.V., S.N.G., G.K., Y.W., J.S., M.A.); Division of Image-guided Therapy and Interventional Oncology, Department of Radiology (S.N.G., J.S.), and Goldyne Savad Institute of Gene Therapy (S.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; and Departments of Radiology and Biomedical Engineering, University of Wisconsin-Madison, Madison, Wis (T.M., C.B.)
| | - Jacob Sosna
- From the Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 1 Deaconess Rd, Boston, MA 02215 (E.V., S.N.G., G.K., Y.W., J.S., M.A.); Division of Image-guided Therapy and Interventional Oncology, Department of Radiology (S.N.G., J.S.), and Goldyne Savad Institute of Gene Therapy (S.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; and Departments of Radiology and Biomedical Engineering, University of Wisconsin-Madison, Madison, Wis (T.M., C.B.)
| | - Tyler Moon
- From the Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 1 Deaconess Rd, Boston, MA 02215 (E.V., S.N.G., G.K., Y.W., J.S., M.A.); Division of Image-guided Therapy and Interventional Oncology, Department of Radiology (S.N.G., J.S.), and Goldyne Savad Institute of Gene Therapy (S.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; and Departments of Radiology and Biomedical Engineering, University of Wisconsin-Madison, Madison, Wis (T.M., C.B.)
| | - Christopher L Brace
- From the Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 1 Deaconess Rd, Boston, MA 02215 (E.V., S.N.G., G.K., Y.W., J.S., M.A.); Division of Image-guided Therapy and Interventional Oncology, Department of Radiology (S.N.G., J.S.), and Goldyne Savad Institute of Gene Therapy (S.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; and Departments of Radiology and Biomedical Engineering, University of Wisconsin-Madison, Madison, Wis (T.M., C.B.)
| | - Muneeb Ahmed
- From the Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 1 Deaconess Rd, Boston, MA 02215 (E.V., S.N.G., G.K., Y.W., J.S., M.A.); Division of Image-guided Therapy and Interventional Oncology, Department of Radiology (S.N.G., J.S.), and Goldyne Savad Institute of Gene Therapy (S.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; and Departments of Radiology and Biomedical Engineering, University of Wisconsin-Madison, Madison, Wis (T.M., C.B.)
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Seror O, N'Kontchou G, Nault JC, Rabahi Y, Nahon P, Ganne-Carrié N, Grando V, Zentar N, Beaugrand M, Trinchet JC, Diallo A, Sellier N. Hepatocellular Carcinoma within Milan Criteria: No-Touch Multibipolar Radiofrequency Ablation for Treatment-Long-term Results. Radiology 2016; 280:611-21. [PMID: 27010381 DOI: 10.1148/radiol.2016150743] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Purpose To assess the long-term outcome in 108 consecutive patients treated with no-touch multibipolar radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) that met the Milan criteria. Materials and Methods This retrospective study was approved by the ethical review board, and the need to obtain informed consent was waived. Between November 1, 2006, and December 31, 2011, 132 HCC tumors (diameter, 10-45 mm; 39 tumors ≥ 30 mm) in 108 consecutive patients (106 with cirrhosis) that met Milan criteria were treated with no-touch multibipolar RFA, which consisted of activating, in bipolar mode, three or four electrodes inserted just beyond the tumor margins. Follow-up was performed every 3 months for 2 years and every 6 months thereafter with computed tomographic or magnetic resonance imaging. Survival probabilities were computed by using the Kaplan-Meier method. Predictive factors of tumor progression and overall survival were assessed by using the Cox proportional hazard model. Results No technical failure occurred, and complete ablation was achieved for all the nodules. After a median of 40.5 months (range, 2-84 months) of follow-up, 3- and 5-year local and overall tumor progression-free survival were 96%, 94%, 52%, and 32%, respectively. Neither tumor diameter greater than 30 mm nor location abutting a large vessel were associated with local tumor progression. Tumor diameter greater than 30 mm was the only parameter predictive of overall tumor progression (P = .0036). Independent factors associated with shorter overall survival were Child-Pugh class B disease, age greater than 65 years, and platelet count of less than 150 g/L (P < .003). Three major complications occurred (2.7%): hemothorax in one patient and liver failure in two, with major portal-systemic shunts. One patient (0.9%) died, and one underwent transplantation. Conclusion No-touch multibipolar RFA for HCC tumors that meet Milan criteria provides a high local tumor progression-free survival rate. An ongoing randomized trial might help to clarify the role of this new approach for the treatment of early HCC. (©) RSNA, 2016 Online supplemental material is available for this article. An earlier incorrect version of this article appeared online. This article was corrected on March 30, 2016.
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Affiliation(s)
- Olivier Seror
- From the Departments of Radiology (O.S., Y.R., N.Z., N.S.) and Hepatology (G.N., J.C.N., P.N., N.G., V.G., M.B., J.C.T.), Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Avenue du 14 juillet, 93140 Bondy, France; Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, Paris, France (O.S., J.C.N., P.N., N.G., J.C.T.); Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France (O.S., J.C.N., P.N., N.G., M.B., J.C.T., N.S.); and Department of Medical Information, l'Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Bobigny, France (A.D.)
| | - Gisèle N'Kontchou
- From the Departments of Radiology (O.S., Y.R., N.Z., N.S.) and Hepatology (G.N., J.C.N., P.N., N.G., V.G., M.B., J.C.T.), Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Avenue du 14 juillet, 93140 Bondy, France; Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, Paris, France (O.S., J.C.N., P.N., N.G., J.C.T.); Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France (O.S., J.C.N., P.N., N.G., M.B., J.C.T., N.S.); and Department of Medical Information, l'Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Bobigny, France (A.D.)
| | - Jean-Charles Nault
- From the Departments of Radiology (O.S., Y.R., N.Z., N.S.) and Hepatology (G.N., J.C.N., P.N., N.G., V.G., M.B., J.C.T.), Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Avenue du 14 juillet, 93140 Bondy, France; Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, Paris, France (O.S., J.C.N., P.N., N.G., J.C.T.); Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France (O.S., J.C.N., P.N., N.G., M.B., J.C.T., N.S.); and Department of Medical Information, l'Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Bobigny, France (A.D.)
| | - Yacine Rabahi
- From the Departments of Radiology (O.S., Y.R., N.Z., N.S.) and Hepatology (G.N., J.C.N., P.N., N.G., V.G., M.B., J.C.T.), Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Avenue du 14 juillet, 93140 Bondy, France; Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, Paris, France (O.S., J.C.N., P.N., N.G., J.C.T.); Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France (O.S., J.C.N., P.N., N.G., M.B., J.C.T., N.S.); and Department of Medical Information, l'Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Bobigny, France (A.D.)
| | - Pierre Nahon
- From the Departments of Radiology (O.S., Y.R., N.Z., N.S.) and Hepatology (G.N., J.C.N., P.N., N.G., V.G., M.B., J.C.T.), Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Avenue du 14 juillet, 93140 Bondy, France; Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, Paris, France (O.S., J.C.N., P.N., N.G., J.C.T.); Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France (O.S., J.C.N., P.N., N.G., M.B., J.C.T., N.S.); and Department of Medical Information, l'Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Bobigny, France (A.D.)
| | - Nathalie Ganne-Carrié
- From the Departments of Radiology (O.S., Y.R., N.Z., N.S.) and Hepatology (G.N., J.C.N., P.N., N.G., V.G., M.B., J.C.T.), Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Avenue du 14 juillet, 93140 Bondy, France; Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, Paris, France (O.S., J.C.N., P.N., N.G., J.C.T.); Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France (O.S., J.C.N., P.N., N.G., M.B., J.C.T., N.S.); and Department of Medical Information, l'Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Bobigny, France (A.D.)
| | - Véronique Grando
- From the Departments of Radiology (O.S., Y.R., N.Z., N.S.) and Hepatology (G.N., J.C.N., P.N., N.G., V.G., M.B., J.C.T.), Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Avenue du 14 juillet, 93140 Bondy, France; Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, Paris, France (O.S., J.C.N., P.N., N.G., J.C.T.); Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France (O.S., J.C.N., P.N., N.G., M.B., J.C.T., N.S.); and Department of Medical Information, l'Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Bobigny, France (A.D.)
| | - Nora Zentar
- From the Departments of Radiology (O.S., Y.R., N.Z., N.S.) and Hepatology (G.N., J.C.N., P.N., N.G., V.G., M.B., J.C.T.), Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Avenue du 14 juillet, 93140 Bondy, France; Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, Paris, France (O.S., J.C.N., P.N., N.G., J.C.T.); Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France (O.S., J.C.N., P.N., N.G., M.B., J.C.T., N.S.); and Department of Medical Information, l'Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Bobigny, France (A.D.)
| | - Michel Beaugrand
- From the Departments of Radiology (O.S., Y.R., N.Z., N.S.) and Hepatology (G.N., J.C.N., P.N., N.G., V.G., M.B., J.C.T.), Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Avenue du 14 juillet, 93140 Bondy, France; Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, Paris, France (O.S., J.C.N., P.N., N.G., J.C.T.); Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France (O.S., J.C.N., P.N., N.G., M.B., J.C.T., N.S.); and Department of Medical Information, l'Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Bobigny, France (A.D.)
| | - Jean-Claude Trinchet
- From the Departments of Radiology (O.S., Y.R., N.Z., N.S.) and Hepatology (G.N., J.C.N., P.N., N.G., V.G., M.B., J.C.T.), Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Avenue du 14 juillet, 93140 Bondy, France; Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, Paris, France (O.S., J.C.N., P.N., N.G., J.C.T.); Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France (O.S., J.C.N., P.N., N.G., M.B., J.C.T., N.S.); and Department of Medical Information, l'Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Bobigny, France (A.D.)
| | - Abou Diallo
- From the Departments of Radiology (O.S., Y.R., N.Z., N.S.) and Hepatology (G.N., J.C.N., P.N., N.G., V.G., M.B., J.C.T.), Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Avenue du 14 juillet, 93140 Bondy, France; Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, Paris, France (O.S., J.C.N., P.N., N.G., J.C.T.); Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France (O.S., J.C.N., P.N., N.G., M.B., J.C.T., N.S.); and Department of Medical Information, l'Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Bobigny, France (A.D.)
| | - Nicolas Sellier
- From the Departments of Radiology (O.S., Y.R., N.Z., N.S.) and Hepatology (G.N., J.C.N., P.N., N.G., V.G., M.B., J.C.T.), Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Avenue du 14 juillet, 93140 Bondy, France; Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, Paris, France (O.S., J.C.N., P.N., N.G., J.C.T.); Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France (O.S., J.C.N., P.N., N.G., M.B., J.C.T., N.S.); and Department of Medical Information, l'Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Bobigny, France (A.D.)
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